雷公藤多苷片联合来氟米特治疗类风湿关节炎效果和安全性的系统评价  

Systematic review of Tripterygium Wilfordii combined with Leflunomide in the treatment of rheumatoid arthritis

作　　者：何斌[1] 刘健[1] HE Bin;LIU Jian(Department of Research Management, the First Affiliated Hospital of Anhui University of Traditional Chinese)

机构地区：[1]安徽中医药大学第一附属医院科研部,安徽合肥230031

出　　处：《中国当代医药》2018年第33期4-7,共4页China Modern Medicine

基　　金：国家中医药管理局中医药重点学科建设项目(国中医药发[2009]30号);国家临床重点专科(中医专业)建设项目(财社[2013]239号)

摘　　要：目的探讨雷公藤多苷片联合来氟米特治疗类风湿关节炎(RA)的效果和安全性。方法全面检索中国知网(CNKI)、维普网(VIP)、万方数据知识服务平台、PubMed、Web of Science、EMbase数据库,纳入雷公藤多苷片联合来氟米特治疗类风湿关节炎的随机对照研究(RCT),对符合要求的文献采用RevMan 5.3.5软件进行Meta分析。结果共纳入4个RCT,包括230例类风湿关节炎患者,其中治疗组116例,对照组114例,治疗组采用雷公藤多苷片联合来氟米特治疗,对照组治疗方法不限制。合并研究结果提示,治疗组在临床有效率、晨僵、血沉及关节痛的改善方面优于对照组,差异有统计学意义(P<0.05)。在临床有效率的改善方面,95%CI=1.02～1.38,合并效应的检验提示Z=2.24,P<0.05;在晨僵的改善方面,95%CI=-0.40～-0.24,Z=7.70,P<0.01;在红细胞沉降率(ESR)的改善方面,95%CI=-14.78～-1.80,Z=2.50,P=0.01;在关节痛的改善方面,95%CI=-2.54～0.01,Z=1.94,P=0.05。但是治疗组在关节肿胀、C反应蛋白(CRP)的改善方面效果不明显,差异无统计学意义(P>0.05)。在关节肿胀的改善情况方面,95%CI=-0.19～0.20,Z=0.01,P=1.00;在C反应蛋白(CRP)改善方面,95%CI=-5.24～0.58,Z=1.57,P>0.05。结论基于纳入研究的方法学质量较低,故不能充分证明治疗组优于对照组,只能提示对于RA的治疗,治疗组可能优于对照组,尚待大样本、高质量的随机对照试验进一步验证。Objective To explore the effectiveness and safety of Tripterygium Wilfordii combined with Leflunomide in the treatment of rheumatoid arthritis(RA). Methods CNKI, VIP, Wanfang Data Knowledge Service Platform, PubMed,Web of Science, EMbase databases were searched comprehensively, and randomized controlled trials(RCT) of Tripterygium Wilfordii combined with Leflunomide in the treatment of RA were included. Meta-analysis was carried out by RevMan 5.3.5 software. Results There were 4 cases of RCTs recruited with 230 patients, which were divided into the experimental group(n=116) and the control group(n=114). The experimental group was treated with Tripterygium Wilfordii combined with Leflunomide, while there was no restriction in the treatment of the control group. The results of Meta-analysis indicated that compared with the control group, the experimental group in the treatment of RA could have better effects in clinical efficiency(95%CI was 1.02 to 1.38, the test of merger effect: Z=2.24, P<0.05), morning stiffness(95%CI was-0.40 to-0.24, Z=7.70, P<0.01), ESR(95%CI was-14.78 to-1.80, Z=2.50, P=0.01), joint pain(95%CI was-2.54 to 0.01, Z=1.94, P=0.05). There was not statistical differences on effects of swollen joints(95%CI was-0.19 to 0.20, Z=0.01, P=1.00), C-reactive protein(95%CI was-5.24 to 0.58, Z=1.57, P>0.05). Conclusion Based on current clinical evidence, Tripterygium Wilfordii combined with Leflunomide in the treatment of RA may be more effective than that in the control group. Nevertheless, it is need to further confirmed by large sample,high quality randomized controlled trials.

关 键 词：雷公藤多苷片 来氟米特 类风湿关节炎 系统评价 随机对照试验 

分 类 号：R684.3[医药卫生—骨科学]