清热除湿中药治疗活动期类风湿性关节炎的系统评价  

System Assessment of Active Stage of Rheumatoid arthritis Treated by Qingrechushi Traditional Chinese Medicine

作　　者：沈伟[1] 杨莉[1] 李媛[1] 

机构地区：[1]成都中医药大学附属医院,成都610072

出　　处：《中国中医药现代远程教育》2012年第10期19-21,共3页Chinese Medicine Modern Distance Education of China

摘　　要：目的评价清热除湿中药联合西药治疗活动期类风湿性关节炎的疗效和安全性。方法检索OVID平台上Cochrane图书馆临床对照试验数据库(CCTR)、美国医学文摘数据库(Medline)、中国期刊全文数据库(CNKI)、维普中文科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)及万方学位论文数据库,并对符合要求的研究进行Meta分析。结果纳入13个研究,方法学质量评价均为C级。Meta-分析显示:在改善活动期类风湿性关节炎的临床综合疗效、关节疼痛或压痛、关节肿胀、晨僵、双手握力、HAQ、ESR、CRP、RF及降低不良反应发生率等方面,清热除湿中药联合西药治疗均优于单纯西药治疗。结论清热除湿中药联合西药治疗活动期类风湿性关节炎较单纯西药治疗更有优势。但由于纳入的临床试验方法学质量较低,并存在多种局限性,以及本研究自身的不足,故现有证据强度不够。尚需进行高质量、能被广泛认同的临床试验予以证实。Objective To review systematically whether there is enough existing evidence about the curative effect and safety of Chinese Herb Clearing Heat and removing dampness combining with Western Medicine against rheumatoid arthritis （RA） patients in active phase. Methods Searching the Cochrane Controlled Trials Registration （CCTR）, Medline, China National Knowledge infrastructure （CNKI）, Chinese VIP database, Chinese Biomedical Literature Database （CBM） and WanFang Database of Dissertation, then the studies met the requirements were reviewed by Meta analysis. Results 13 Chinese RCTs and quasi-RCTs meet the criterion. The results of Meta-analysis indicated： （1）Compared Western Medicine alone, combining Chinese Herb Clearing Heat and removing dampness is better for RA patients in active phase on effective rate, joint pain or tenderness, joint swelling, morning stiffness, hand grip strength,HAQ,ESR, CRP, RF,IgG and reducing the incidence of adverse reactions; （2） But no significant difference was found in the improvement of articular dyskinesia,15 meter walking time, IgA and IgM. Conclusion This study demonstrated that Chinese Herbs Clearing Heat and removing dampness combining with Western Medicine have an advantage over Western Medicine alone in RA patients in active phase. However the poor methodological quality of included studies seriously weakened the validity of the meta-analysis which were needed to further assess by the high quality and large sample sized RCTs.

关 键 词：清热除湿 中医药疗法 类风湿性关节炎 活动期 系统评价 META-分析 

分 类 号：R259[医药卫生—中西医结合]