桂枝芍药知母汤联合化学药物治疗类风湿关节炎临床疗效的Meta分析  

Clinical Efficacy of Guizhi Shaoyao Zhimu Decoction Combined with Chemical Drugs in the Treatment of Rheumatoid Arthritis:A Meta-analysis

作　　者：刘杏[1] 李鑫[1] 夏宇 满荣勇[2] 曹建中 LIU Xing;LI Xin;XIA Yu;MAN Rongyong;CAO Jianzhong(Hunan Provincial Key Laboratory of Diagnostics in Chinese Medicine,Hunan University of Chinese Medicine,Changsha 410208,China;The First People′s Hospital of Huaihua,Huaihua 418000,China)

机构地区：[1]湖南中医药大学中医诊断学湖南省重点实验室,长沙410208 [2]怀化市第一人民医院,怀化418000

出　　处：《世界中医药》2024年第22期3479-3492,共14页World Chinese Medicine

基　　金：国家自然科学基金青年项目(81803993)——基于Th17/Treg细胞失衡的乌头汤治疗类风湿关节炎风寒湿痹证方证对应研究。

摘　　要：目的:阐明桂枝芍药知母汤联合化学药物治疗类风湿关节炎(RA)的临床疗效与安全性。方法:计算机检索国家知识基础设施数据库(CNKI)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD)、中国生物医学文献服务系统、PubMed、Cochrane Library等中英文数据库,并且手工协助检索相关文献,防止漏检,检索时限均从建库至2021年3月21日。采用Cochrane协作网偏倚风险评价标准进行文献筛选、资料提取和质量评价,采用RevMan 5.3软件进行Meta分析。结果:共纳入18项研究,总计1683例患者。Meta分析表明,相对于化学药物,桂枝芍药知母汤联合化学药物对28个关节疾病活动度评分(DAS28)改善更显著(MD=1.11,95%CI为0.61~1.62,P<0.00001)。桂枝芍药知母汤联合化学药物的总有效率优于单纯使用化学药物治疗RA(OR=4.95,Z=9.73,P<0.00001)。桂枝芍药知母汤联合化学药物可明显改善关节疼痛数(MD=1.21,95%CI为0.25~2.18,P=0.01)、双手握力(MD=14.14,95%CI为11.72~16.55,P<0.00001)等临床症状。并能有效改善类风湿因子(SMD=1.19,95%CI为0.46~1.92,P=0.001)、C反应蛋白(MD=3.77,95%CI为1.26~6.28,P=0.003)及红细胞沉降率(MD=8.09,95%CI为3.40~12.77,P=0.0007)等实验室检测指标。桂枝芍药知母汤可显著降低化学药物单独使用引起的不良反应发生率(RR=0.24,95%CI为0.14~0.42,P<0.00001)。结论:桂枝芍药知母汤联合化学药物治疗RA疗效优于单用化学药物,且有效改善临床症状及实验室检测指标,比单独使用化学药物更安全。Objective:To evaluate the clinical efficacy and safety of Guizhi Shaoyao Zhimu Decoction in combination with chemical drugs for the treatment of rheumatoid arthritis(RA).Methods:A computer-based search was conducted across multiple databases,including CNKI,CSPD,CCD,China Biology Medicine(CBM),PubMed,and Cochrane Library,with the search covering both Chinese and English literature from the inception of the databases up to March 21,2021.Manual assistance was also used to retrieve relevant studies to avoid missing any literature.The Cochrane Collaboration′s risk of bias assessment criteria were used for literature screening,data extraction,and quality evaluation.Meta-analysis was performed using RevMan 5.3 software.Results:A total of 18 studies,including 1683 patients,were included in this research.The Meta-analysis showed that,compared to chemical drugs alone,Guizhi Shaoyao Zhimu Decoction combined with chemical drugs significantly improved the DAS28 score(MD=1.11,95%CI 0.61 to 1.62,P<0.0001).The total effective rate of the combination therapy was superior to that of chemical drugs alone(OR=4.95,Z=9.73,P<0.0001).The combination therapy significantly improved clinical symptoms,such as joint pain count(MD=1.21,95%CI 0.25 to 2.18,P=0.01)and grip strength in both hands(MD=14.14,95%CI 11.72 to 16.55,P<0.00001).It also effectively improved laboratory indicators,including rheumatoid factor(SMD=1.19,95%CI 0.46 to 1.92,P=0.001),C-reactive protein(MD=3.77,95%CI 1.26 to 6.28,P=0.003),and erythrocyte sedimentation rate(MD=8.09,95%CI 3.40 to 12.77,P=0.0007).Guizhi Shaoyao Zhimu Decoction significantly reduced the incidence of adverse reactions caused by chemical drugs alone(RR=0.24,95%CI 0.14 to 0.42,P<0.0001).Conclusion:Guizhi Shaoyao Zhimu Decoction in combination with chemical drugs is more effective than chemical drugs alone in the treatment of RA.It improves clinical symptoms and laboratory markers and is safer than using chemical drugs alone.

关 键 词：桂枝芍药知母汤 化学药物 类风湿关节炎 临床疗效 安全性 META分析 系统评价 

分 类 号：R242[医药卫生—中医临床基础] R289.5[医药卫生—中医学]