雷公藤多苷(甙)片单用或联合甲氨蝶呤治疗类风湿关节炎实验室指标改善作用的Meta分析  

Meta-analysis of laboratory index of Tripterygium Glycosides Tablets in treatment of rheumatoid arthritis

作　　者：李泰贤 王晓月 薛志鹏 吕诚[3] 李慧珍 樊媛芳 李逸群 田雅格 杨俊 陈文佳 郭敏群 王靖霞 吴红艳 陈卫衡[2] 张彦琼 林娜[1] LI Tai-xian;WANG Xiao-yue;XUE Zhi-peng;LYU Cheng;LI Hui-zhen;FAN Yuan-fang;LI Yi-qun;TIAN Ya-ge;YANG Jun;CHEN Wen-jia;GUO Min-qun;WANG Jing-xia;WU Hong-yan;CHEN Wei-heng;ZHANG Yan-qiong;LIN Na(Institute of Chinese Materia Medica,China Academy of Chinese Medical Sciences,Beijing 100700,China;Wangjing Hospital of China Academy of Chinese Medical Sciences,Beijing 100102,China;Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China)

机构地区：[1]中国中医科学院中药研究所,北京100700 [2]中国中医科学院望京医院,北京100102 [3]中国中医科学院中医临床基础医学研究所,北京100700

出　　处：《中国中药杂志》2019年第16期3542-3550,共9页China Journal of Chinese Materia Medica

基　　金：北京市自然科学基金项目(7192139);中国中医科学院中医药“一带一路”合作专项(GH2017-06);中国中医科学院基本科研业务费自主选题项目院内联合创新专项(Z2017082)

摘　　要：系统评价雷公藤多苷(甙)片(TGT)单用或联合甲氨蝶呤(MTX)对改善类风湿关节炎(RA)实验室检验指标的作用,为临床应用TGT治疗RA提供指导。该研究通过系统检索CNKI、万方、维普、PubMed、EMbase及Cochrane数据库,收集TGT单用或联合MTX治疗RA的随机对照试验,应用风险评估工具进行研究质量评价,采用RevMan 5.3软件对纳入文献提取的实验室指标进行Meta分析。共检索到1 709篇文献,最终纳入25篇,总样本量2 507例。Meta分析结果显示:TGT单独用药与MTX单独用药对照:MDESR=-2.66,95%CI[-8.17,2.86],P=0.35;MDCRP=-2.38,95%CI[-9.01,4.24],P=0.48;TGT联合MTX治疗与MTX单独用药对照:MDESR=8.74,95%CI[6.72,10.76],P<0.000 01;MDCRP=5.37,95%CI[3.71,7.03],P<0.000 01;SMDRF=1.05,95%CI[0.51,1.60],P=0.000 1。表明TGT单独用药对RA患者的CRP和ESR的改善作用与MTX相当;TGT联合MTX对CRP,ESR,RF的改善作用优于MTX单独使用。TGT无论是单用还是联用MTX均有改善RA患者实验室检验指标的作用,值得临床推广应用。由于受纳入文献质量的限制和临床异质性的影响,研究结果尚有待临床实践验证。The aim of this study was to systematically evaluate the clinical efficacy of Tripterysium Glycosides Tablets(TGT)alone or in combination with methotrexate(MTX)in the treatment of rheumatoid arthritis(RA)based on the laboratory index criteria and to provide a basis for the clinical application of TGT against RA.Six databases including CNKI,WanFang,VIP,PubMed,EMbase and Cochrane were retrieved for randomized controlled trials(RCT)about TGT alone or combination with MTX in the treatment of RA.Then risk assessment tools were used for quality evaluation of the studies,and data extraction and analysis were conducted by using RevMan 5.3 software for Meta-analysis.A total of 1 709 articles were retrieved,and finally 25 studies were included,with a total sample size of 2 507 cases.Meta-analysis results showed that between TGT alone and TGT alone,MDESR=-2.66,95%CI[-8.17,2.86],P=0.35;MDCRP=-2.38,95%CI[-9.01,4.24],P=0.48;between TGT combined with MTX and MTX alone,MDESR=8.74,95%CI[6.72,10.76],P<0.000 01;MDCRP=5.37,95%CI[3.71,7.03],P<0.000 01;SMDRF=1.05,95%CI[0.51,1.60],P=0.000 1.The effect of TGT on decreasing CRP and ESR in RA patients was similar to the MTX.In addition,TGT combined with MTX were more effective in decreasing CRP,ESR,RF than MTX alone.However,due to the potential bias in the included studies,more and high-quality randomized controlled trials would be needed to improve the level of evidence.

关 键 词：雷公藤多苷(甙)片 类风湿关节炎 系统评价 META分析 实验室指标 

分 类 号：R71[医药卫生—妇产科学]