5种中药汤剂治疗类风湿性关节炎有效性和安全性的网状Meta分析  

Efficacy and safety of five kinds of traditional Chinese medicine decoction in the treatment of rheumatoid arthritis:a network Meta-analysis

作　　者：沈子扬 刘树民[2] 于栋华[2] SHEN Ziyang;LIU Shumin;YU Donghua(Graduate School of Heilongjiang University of Chinese Medicine,Harbin 150040,China;Institute of Chinese Medicine,Heilongjiang University of Chinese Medicine,Harbin 150040,China)

机构地区：[1]黑龙江中医药大学研究生院,哈尔滨150040 [2]黑龙江中医药大学中医药研究院,哈尔滨150040

出　　处：《药物流行病学杂志》2024年第8期884-898,共15页Chinese Journal of Pharmacoepidemiology

基　　金：国家自然科学基金青年科学基金项目(81803871);黑龙江省中医局青年中医药科研课题(ZHY2023-187)。

摘　　要：目的系统评价常用的5种中药汤剂治疗类风湿关节炎(RA)的疗效及安全性。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、CNKI、WanFang Data和VIP数据库,搜集蠲痹汤、乌头汤、白虎加桂枝汤、桂枝芍药知母汤和独活寄生汤等5种中药汤剂联合甲氨蝶呤、美洛昔康等常规疗法治疗RA的随机对照试验(RCT),检索时限均从建库至2024年1月1日,由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 17软件进行网状Meta分析。结果共纳入35个RCT,包括3316例患者。网状Meta分析结果显示,与单纯常规疗法相比,5种中药汤剂+常规疗法均显著提高临床总有效率(P<0.05),蠲痹汤+常规疗法、桂枝芍药知母汤+常规疗法、独活寄生汤+常规疗法均显著降低类风湿因子(RF)水平(P<0.05),蠲痹汤+常规疗法、乌头汤+常规疗法、桂枝芍药知母汤+常规疗法、独活寄生汤+常规疗法均显著降低C-反应蛋白(CRP)水平和血清红细胞沉降率(ESR)(P<0.05),桂枝芍药知母汤+常规疗法、独活寄生汤+常规疗法均显著降低不良反应发生率(P<0.05)。累积概率排序结果显示,桂枝芍药知母汤+常规疗法对提高临床总有效率、降低RF水平、降低不良反应发生率的效果均最佳,乌头汤+常规疗法对降低CRP水平的效果最佳,蠲痹汤+常规疗法对降低血清ESR效果最佳。结论中药汤剂与常规疗法联合应用治疗RA的效果显著优于单纯常规疗法,在改善指标方面,可选择桂枝芍药知母汤或蠲痹汤联合常规疗法;在提高安全性方面,可选择桂枝芍药知母汤或独活寄生汤联合常规疗法。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。Objective To evaluate efficacy and safety of 5 different Chinese herbal decoctions in the treatment of rheumatoid arthritis(RA)by network Meta-analysis.Methods PubMed,Embase,Cochrane Library and Web of Science,CNKI,WanFang Data and VIP databases were electronically searched to collect randomized controlled trials(RCTs)of 5 kinds of traditional Chinese medicine decoctions(Juanbi decoction,Wutou decoction,Baihu plus Guizhi decoction,Guizhi Shaoyao Zhimu decoction and Duhuo Jisheng decoction)combined with conventional treatment such as methotrexate and meloxicam from inception to January 1,2024.Two reviewers independently screened literature,extracted data and assessed risk bias of included studies.The network Meta-analysis was then performed using Stata 17 software.Results A total of 35 RCTs involving 3316 patients were included.The results of the network Meta-analysis found that compared with conventional treatment,5 kinds of traditional Chinese medicine decoction+conventional treatment significantly increased total clinical effective rate(P<0.05);Juanbi decoction+conventional treatment,Guizhi Shaoyao Zhimu decoction+conventional treatment,Duhuo Jisheng decoction+conventional treatment significantly reduced RF level(P<0.05);Juanbi decoction+conventional treatment,Wutou decoction+conventional treatment,Guizhi Shaoyao Zhimu decoction+conventional treatment,Duhuo Jisheng decoction+conventional treatment significantly reduced CRP level and ESR level(P<0.05);Guizhi Shaoyao Zhimu decoction+conventional treatment,Duhuo Jisheng decoction+conventional treatment significantly reduced incidence of adverse reactions(P<0.05).The cumulative probability ranking results showed that Guizhi Shaoyao Zhimu decoction+conventional treatment had the best effect in improving the total clinical effective rate and reducing RF level and incidence of adverse reactions;Wutou decoction+conventional treatment had the best effect in reducing CRP level;Juanbi decoction+conventional treatment had the best effect in reducing ESR level.Conclusion Tr

关 键 词：类风湿关节炎 蠲痹汤 乌头汤 白虎加桂枝汤 桂枝芍药知母汤 独活寄生汤 网状Meta分析 随机对照试验 

分 类 号：R259[医药卫生—中西医结合]