Clinical efficacy of Chinese herbs for supplementing qi and activating blood circulation combined with N-acetylcysteine in the treatment of idiopathic pulmonary fibrosis: A systematic review and network meta-analysis

• Published in: PloS one 2022-03, Vol.17 (3), p.e0265006-e0265006
• Main Authors: Pang, Qinglu, Li, Guodong, Cao, Fang, Liu, Haoge, Wei, Wan, Jiao, Yang
• Format: Article
• Language: English
• Subjects: Acetylcysteine; Acetylcysteine - therapeutic use; Bias; Biology and Life Sciences; Blood; Blood circulation; Blood gas analysis; Care and treatment; Chinese medicine; Clinical trials; Diagnosis; Fibrosis; Gas analysis; Geriatrics; Health aspects; Herbs; Hospitals; Humans; Idiopathic Pulmonary Fibrosis - drug therapy; Internal medicine; Lung diseases; Medical research; Medicine and Health Sciences; Meta-analysis; Network Meta-Analysis; Oxidative stress; Oxygen - therapeutic use; Pathogenesis; Physical Sciences; Pulmonary fibrosis; Research and Analysis Methods; Respiratory function; Statistical analysis; Treatment Outcome
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0265006

Chinese herbs for supplementing qi and activating blood circulation (CH) combined with N-acetylcysteine (NAC) is widely used for idiopathic pulmonary fibrosis (IPF) in China, but there is a lack of literature to evaluate its efficacy and clinical value. This study compared CH + NAC with other treatments by network meta-analysis to clarify its clinical value. Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure, WanFang Data, VIP Database, and China Biology Medicine were searched. Outcomes included lung function (DLCO (%), VC (%), FVC (%), FVC (L)), 6-min walking distance (6MWD), score of St George's respiratory questionnaire (SGRQ), blood gas analysis (PaO2, PaCO2). The data were analyzed by Review Manager 5.4, Stata 12.0 and ADDIS 1.16.5. 23 studies including 1390 patients (702 in intervention group and 688 in control group) were collected to compare 8 outcome indicators among different treatments involving CH, CH+NAC, CH+PFD, NAC, PFD and PFD+NAC on IPF. Network meta-analysis showed that CH was better than NAC in terms of DLCO (%) (MD = 5.14, 95%CI: 1.01 to 8.68) and 6MWD (MD = 49.17, 95%CI: 25.97 to 71.36) as well as PFD + NAC was better than NAC in terms of FVC (L) (MD = -0.56, 95%CI: -0.83 to -0.31). In rankings results, CH + NAC is the best in terms of FVC (%), SGRQ, PaO2 and PaCO2; CH is the best in terms of DLCO (%), VC (%) and 6MWD; CH + PFD is the best in terms of FVC (L). CH related treatments may have advantages in the treatment of IPF and CH + NAC may have clinical application value. However, limited by the quality and quantity of researches included, more rational and scientific randomized controlled trials containing large sample sizes need to be conducted to further verify our conclusions.