黄芪桂枝五物汤治疗类风湿关节炎临床疗效的Meta分析  

Meta-analysis of Clinical Effi cacy of Huangqi Guizhi Wuwu Tang(黄芪桂枝五物汤)in the Treatment of Rheumatoid Arthritis

作　　者：蒋总 唐芳 马武开 卢向阳 陈琳英 李宇 兰维娅 姚晓玲 樊梅 蔡鑫 JIANG Zong;TANG Fang;MA Wu-kai;LU Xiang-yang;CHEN Lin-ying;LI Yu;LAN Wei-ya;YAO Xiao-ling;FAN Mei;CAI Xin

机构地区：[1]贵州中医药大学,贵州贵阳550002 [2]贵州中医药大学第二附属医院,贵州贵阳550001

出　　处：《风湿病与关节炎》2019年第5期33-38,共6页Rheumatism and Arthritis

基　　金：国家自然科学基金(81460727;81760866);贵州省科学技术基金(黔科合基础〔2016〕1011);贵州省中医药(民族医药)治疗风湿病医学平台建设(黔科合平台人才〔2018〕5707)

摘　　要：目的:探讨黄芪桂枝五物汤治疗类风湿关节炎的临床疗效。方法:计算机检索中国知网(CNKI)、万方(WANFANG)、维普(VIP)、中国生物医学文献数据库(CBM)、Pumbed、Medline等数据库,以黄芪桂枝五物汤加减联合常规西药治疗类风湿关节炎随机对照试验(RCT)为研究对象,检索时间为数据库建立至2018年12月。文献提取和验证由2位研究员独立完成,提取文献资料及评估偏倚风险,并采用RevMan 5.3软件进行RCT的定向合成。结果:共纳入11个RCT研究,总样本量为935例,其中试验组475例,对照组460例。Meta分析结果显示,黄芪桂枝五物汤联合西药能提高疗效(RR=1.30,95%CI=[1.22,1.39],P <0.000 01),且黄芪桂枝五物汤联合西药改善晨僵时间(WMD=-1.02,95%CI=[-1.99,-0.05],P=0.04)、C-反应蛋白(WMD=-0.61,95%CI=[-0.99,-0.24],P=0.001)、类风湿因子(WMD=-0.19,95%CI=[-0.37,-0.00],P=0.05)均优于常规西药组,但2组红细胞沉降率(WMD=-0.16,95%CI=[-0.80,0.47],P=0.61)差异无统计学意义。5篇文献提及不良反应,其余6篇未提及。结论:黄芪桂枝五物汤联合西药治疗类风湿关节炎比单用西药有更好的疗效,且不良反应显著降低。Objective:To explore the clinical efficacy of Huangqi Guizhi Wuwu Tang(黄芪桂枝五物汤)on rheumatoid arthritis.Methods:Databases such as CNKI,WANFANG,VIP,CBM,Pumbed and Medline were searched by computer(from the establishment of databases to December 2018)for randomized controlled trials(RCT)of treating rheumatoid arthritis with modified Huangqi Guizhi Wuwu Tang combining conventional western medicine.Literature extraction and validation were done by two researchers independently.Literature data were extracted and bias risk was assessed.RevMan 5.3 software was used to synthesize RCT.Results:A total of eleven RCT studies were included.The total sample size was 935 cases,475 cases in the experimental group and 460 cases in the control group.Meta analysis showed that Huangqi Guizhi Wuwu Tang combined with western medicine could improve the efficacy(RR = 1.30,95%CI =[1.22,1.39],P < 0.000 01),and Huangqi Guizhi Wuwu Tang combined with western medicine was better in the improvement of morning stiffness time(WMD =-1.02,95%CI =[-1.99,-0.05],P = 0.04),C-reactive protein(WMD =-0.61,95% CI =[-0.99,-0.24],P = 0.001),and rheumatic factor(WMD =-0.19,95% CI =[-0.37,-0.00],P = 0.05)in the experimental group than those in the control group.There was no significant difference in erythrocyte sedimentation rate(WMD =-0.16,95% CI =[-0.80,0.47],P = 0.61)between the two groups. Adverse reactions were mentioned in five pieces of literature and not in the other six.Conclusion:Huangqi Guizhi Wuwu Tang combined with western medicine has a better curative effect on rheumatoid arthritis than using western medicine alone,and the adverse reactions are significantly reduced.

关 键 词：关节炎 类风湿 黄芪桂枝五物汤 随机对照试验 META 分析 

分 类 号：R259[医药卫生—中西医结合]