中西医结合治疗风湿性多肌痛的疗效及安全性的Meta分析

A meta-analysis of the efficacy and safety of the integrative medicine on rheumatic polymyalgia

目的:系统评价中西医结合风湿性多肌痛的疗效及安全性。方法:计算机检索中国知网、万方、中国生物医学文献数据库、维普、PubMed、the Cochrane library等数据库,检索时间为数据库建立时间至2021年4月;收集以常规西药治疗为对照组,中西医结合治疗为试验组治疗风湿性多肌痛的临床文献,分别由2名研究员独立进行文献筛选、提取文献资料、风险评估后,采用RevMan 5.3软件进行数据分析。结果:纳入22篇文献,总样本量为1790例,试验组906例,对照组884例,Meta分析结果显示:中西医结合治疗风湿性多肌痛在总有效率(OR=4.54,95%CI[3.34,6.16],P<0.00001)、红细胞沉降率(Erythrocyte Sedimentation Rate,ESR)(MD=-9.75,95%CI[-12.51,-6.98],P<0.00001)、C反应蛋白(C-reactive Protein,CRP)(SMD=-1.66,95%CI[-2.28,-1.05],P<0.00001)、风湿性多肌痛活动评分(Rheumatic Polymyalgia Activity Score,PMR-AS)(MD=-6.04,95%CI[-7.63,-4.45],P<0.00001)、血红蛋白(Hemoglobin,Hb)(SMD=5.55,95%CI[2.56,8.54],P=0.0003)、血小板(Platelet,PLT)(SMD=-2.59,95%CI[-3.92,-1.27],P=0.0001)、不良反应(OR=0.41,95%CI[0.29,0.59],P<0.00001)等方面优于对照组,且不良反应反生率低于对照组。结论:中西医结合治疗风湿性多肌痛对比单纯西药治疗,在总有效率、ESR、CRP、PMR-AS、Hb、PLT、不良反应等方面疗效更好,但是由于纳入文献的数量有限、质量低,仍需要高质量、大样本的随机对照试验进一步证实。

Objective:To systematically evaluate the efficacy and safety of the integrative medicine on rheumatic polymyalgia.Methods:In China national knowledge infrastructure,Wanfang,CBM,VIP,PubMed,the Cochrane Library and other databases,the clinical studies on treating rheumatic polymyalgia with conventional Western medicine as the control group and in the integrative medicine as the experimental group were retrieved by computer.The retrieval time was from the databases establishment to April 2021.Two researchers independently screened the literature,extracted the literature and assessed the risk,and then analyzed the data by RevMan 5.3 software.Results:22 studies were included,with a total sample size of 1790 cases,including 906 cases in the experimental group and 884 cases in the control group.The Meta-analysis results showed that the integrative medicine on rheumatic polymyalgia showed better clinical effects compared with conventional Western medicine in the total efficiency(OR=4.54,95%CI[3.34,6.16],P<0.00001),ESR(MD=-9.75,95%CI[-12.51,-6.98],P<0.00001),CRP(SMD=-1.66,95%CI[-2.28,-1.05],P<0.00001),PMR-AS(MD=-6.04,95%CI[-7.63,-4.45],P<0.00001),Hb(SMD=5.55,95%CI[2.56,8.54],P=0.0003),PLT(SMD=-2.59,95%CI[-3.92,-1.27],P=0.0001),and adverse reactions(OR=0.41,95%CI[0.29,0.59],P<0.00001),and the adverse reactions rate was lower than that in the control group.Conclusion:Compared with Western medicine alone,the integrative medicine on rheumatic polymyalgia shows better clinical efficacy in the total efficiency,ESR,CRP,PMR-AS,Hb,PLT,adverse reactions and so on.However,due to the limited number and low quality of included literature,the high-quality and large-sample randomized controlled trials are still needed for further confirmation.