常见中药方剂治疗急性痛风性关节炎疗效及安全性的网状Meta分析  

Efficacy and Safety of Chinese Medicinal Prescriptions in Treatment of Acute Gouty Arthritis:A Network Meta-analysis

作　　者：方锦颖 刘明煊 黄正慧 马玉草 王艺文 吕柳 刘春平[1] 李威 郑晓佳 朱振红 朱华超 胡杰 王永宏 王海隆 FANG Jinying;LIU Mingxuan;HUANG Zhenghui;MA Yucao;WANG Yiwen;LYU Liu;LIU Chunping;LI Wei;ZHENG Xiaojia;ZHU Zhenhong;ZHU Huachao;HU Jie;WANG Yonghong;WANG Hailong(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院,北京100700

出　　处：《中国实验方剂学杂志》2023年第12期175-184,共10页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家重点研发计划项目(2022YFC3501203);国家自然科学基金项目(8217152586);首都卫生发展科研专项(首发2022-2-7087);北京市通州区科技计划项目(KJ2022CX045)。

摘　　要：目的:对于急性痛风性关节炎(AGA)的治疗目前多采用西药抗炎止痛,控制血尿酸水平,但仍有部分患者控制不佳,反复出现发作。中药方剂能够抗炎止痛,稳定患者血尿酸水平,减少急性发作,提高西药临床疗效,但仍缺少循证医学依据。该研究采用网状Meta分析评价常见中药方剂治疗AGA疗效及安全性,为临床使用中药方剂治疗AGA提供循证医学证据。方法:检索中英文数据库获取所有中药方剂治疗AGA的前瞻性队列研究及随机对照试验。所有检索均从数据库建立至2022年12月1日。使用Stata软件和Review Manager进行相关统计分析。结果:最终得到文献44篇,包含患者3 564例。研究结果表明,在降低血尿酸方面,累计概率排序结果显示麻黄连翘赤小豆汤(87.60%)疗效最佳;在缓解关节疼痛方面,当归拈痛汤(92.00%)和桂枝芍药知母汤(82.30%)疗效较佳。在改善血沉(ESR)方面,四妙丸(87.00%)改善AGA患者ESR水平优于其他药物治疗。在降低C反应蛋白方面,四妙丸(76.00%)和白虎加桂枝汤(66.10%)表现较佳。在安全性方面,除基础治疗组外,麻黄连轺赤小豆汤发生不良事件发生概率最低,当归拈痛汤治疗过程中发生不良反应可能性最高。聚集分析结果显示,麻黄连翘赤小豆汤及四妙丸的疗效较好及安全性较高。结论:该研究表明,中药方剂能够治疗AGA,提高西药临床疗效。对于AGA患者,临床医生可以优先选择麻黄连翘赤小豆汤或四妙丸。Objective:In the treatment of acute gouty arthritis(AGA),western medicine is mostly used for anti-inflammatory and analgesic purposes to control the blood uric acid level,but some patients are still at risk of poor control and recurrent attacks.Chinese medicinal prescriptions,potent in resisting inflammation and relieving pain,are able to stabilize the blood uric acid level,reduce acute attacks,and improve the clinical efficacy of western medicine.However,there is a lack of evidence to support their use as evidence-based medicine.This study employed network Meta-analysis(NMA) to evaluate the efficacy and safety of common Chinese medicinal prescriptions in the treatment of AGA,aiming to provide evidence-based medical evidence for the clinical use of Chinese medicinal prescriptions in the treatment of AGA.Method:Chinese and English databases were searched for prospective cohort studies and randomized controlled trials(RCTs) on Chinese medicinal prescriptions against AGA from database inception to December 1,2022.Stata software and Review Manager were used for statistical analysis.Result:Forty-four papers with 3 564 cases involved were included in the current NMA.In terms of reducing blood uric acid,the cumulative probability results showed that Mahuang Lianyao Chixiaodou Tang showed optimal efficacy(87.60%).In terms of relieving joint pain,Danggui Niantongtang and Guizhi Shaoyao Zhimutang showed optimal efficacy(92.00% and 82.30%).In terms of improving erythrocyte sedimentation rate(ESR),Simiaowan was superior to other prescriptions(87.00%).In terms of reducing C-reactive protein(CRP),Simiaowan and Baihutang modified with Guizhitang showed superior efficacy(76.00% and 66.10%).In terms of safety,except for the basic treatment group,Mahuang Lianyao Chixiaodou Tang had the lowest probability of adverse events,and Danggui Niantongtang had the highest probability of adverse reactions during treatment.According to the results of cluster analysis,Mahuang Lianyao Chixiaodou Tang and Simiaowan are effective and safe.Conclus

关 键 词：痛风性关节炎 中药方剂 四妙丸 麻黄连翘赤小豆汤 网状Meta分析 

分 类 号：R284[医药卫生—中药学] R285[医药卫生—中医学] R289R287R22R2-031R33R24