补益肝肾法治疗斑秃的Meta分析  

Meta-Analysis of Nourishing Liver and Kidney for Alopecia Areata

作　　者：林文君 李小婷 窦丹 曲保全 吕书影 杨顶权[1,2] LIN Wen-jun;LI Xiao-ting;DOU Dan;QU Bao-quan;LYU Shu-ying;YANG Ding-quan(Beijing University of Chinese Medicine,Beijing 100029;Department of Dermatology and Venereology,China-Japan Friendship Hospital,Beijing 100029;Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine,Beijing 100700)

机构地区：[1]北京中医药大学,北京100029 [2]中日友好医院皮肤与性病科,北京100029 [3]北京中医药大学东直门医院,北京100700

出　　处：《世界中西医结合杂志》2021年第11期1972-1979,1984,共9页World Journal of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金资助项目(81973691)。

摘　　要：目的评价补益肝肾法治疗斑秃(Alopecia areata,AA)的临床疗效及其安全性。方法计算机检索中国期刊全文数据库(CNKI)、万方数据库(WanFang)、维普网(VIP)、中国生物医学文献数据库(CBM)、PubMed等数据库,检索时间限定为建库至2021年3月,检索所有具有补益肝肾功效的中药复方治疗AA的随机对照试验(Randomized Controlled Trial,RCT),采用Cochrane系统评价手册进行文献方法学质量评价,采用RevMan 5.3统计学软件进行Meta分析。结果最终纳入14项研究,共1321例患者,分析结果显示:与对照组比较,采用补益肝肾法能有效提高AA患者临床有效率[OR=6.14,95%CI=(4.21,8.96)],降低复发率[OR=0.27,95%CI(0.10,0.71)],降低SALT评分[MD=-9.75,95%CI=(-18.88,-0.62)],差异有统计学意义(P<0.0001);且有效率“倒漏斗”图形左右对称,表明所纳入的研究存在发表偏倚的可能性较小;在免疫指标方面,补益肝肾法治疗组的外周血CD8+水平明显低于对照组[MD=-7.22,95%CI=(-10.74,-3.70)],但两种疗法在调节CD4+水平上存在较大异质性,无法进行Meta分析。纳入的临床研究使用补益肝肾法高频中药为:何首乌、女贞子、当归、枸杞子、熟地黄。结论补益肝肾法治疗AA疗效良好且安全可靠,值得临床推广,但仍需高质量的临床研究进一步进行验证;同时,补益肝肾法对AA患者免疫功能的影响存在较大差异,提示还需要开展大规模、规范化研究,为AA发病的免疫机制及其治疗靶点的探索提供临床基础。Objective To evaluate clinical efficacy and safety of nourishing liver and kidney for the treatment of alopecia areata(AA).Methods The data were searched from National Knowledge Infrastructure(CNKI),Wanfang database,VIP network,Chinese biomedical literature database(CBM)and PubMed by computer.The retrieval time was limited from the establishment of the database to March 2021.All randomized controlled trials(RCTs)related to the treatment of AA with the compound prescription of nourishing liver and kidney were searched.According to the requirement of the Cochrane system evaluator manual 5.1,the quality of the study included were strictly evaluated and meta-analysis of outcome indicators were carried out by RevMan 5.3 software.Results Fourteen studies altogether 1321 cases of patients were included.The results of the analysis showed that:compared with the control group,the method of nourishing liver and kidney could effectively improve the clinical total effective rate[OR=6.14,95%CI=(4.21,8.96)],reduce recurrence rate[OR=0.27,95%CI(0.10,0.71)]and decrease SALT scores[MD=-9.75,95%CI=(-18.88,-0.62)]of the patients with AA,and the difference was statistically significant(P<0.0001).The effective“Inverted funnel”pattern is symmetrical,indicating that the included studies is less likely to have the publication bias.As to the immunity index,the CD8+level of peripheral blood in the treatment group was significantly lower than that in the control group[MD=-7.22,95%CI=(-10.74,-3.70)].While there is a large heterogeneity in the level of CD4+between the two therapies,which can not be meta analyzed.The high frequency Chinese medicine of nourishing liver and kidney is Polygonum multiflorum,Ligustrum lucidum,Angelica sinensis,Lycium barbarum and Radix Rehmanniae Praeparata.Conclusion The method of nourishing liver and kidney is safe and effective for the treatment of AA,which is worthy of clinical promotion but still needs high quality clinical research to further support the verification.Meanwhile,the effect of nourishing liv

关 键 词：补益肝肾 斑秃 随机对照 META分析 中医药 有效率 

分 类 号：R758.71[医药卫生—皮肤病学与性病学]