以甲氨蝶呤为对照的中药治疗类风湿关节炎系统评价

Systems evaluation on traditional Chinese medicine in treating rheumatoid arthritis contrasts to methotrexate

目的评价与甲氨蝶呤相比中药治疗类风湿关节炎的疗效与安全性。方法检索CBM、CNKI和MEDLINE数据库,收集中药与甲氨蝶呤为对照治疗类风湿关节炎的随机或半随机的对照试验,应用系统评价方法对纳入文献进行系统评价。结果符合纳入标准的7个研究,采用Jadad记分法,均在3分以下,无一篇为高质量试验;对其中3个研究资料合并进行Meta分析,结果提示与甲氨蝶呤相比,中药正清风痛宁缓释片在减少RA患者的关节肿胀数、缩短晨僵时间、降低RF滴度方面均显著优于甲氨蝶呤,但在关节压痛数减少、血沉降低方面与甲氨蝶呤相比则无显著性差异。结论因中药治疗类风湿关节炎的试验措施大多不一致,可合并进行Meta分析的文献资料少,且由于纳入评价的文献方法学质量较低以及可能有发表性偏倚的存在,中药治疗类风湿关节炎的有效性及安全性有待于严格设计的大样本、多中心的随机双盲对照试验加以证实。

Objective It is to evaluate the curative effect and safety of traditional Chinese medicine therapy on rheumatoid arthritis（RA）,which contrasts to methotrexate（MTX）.Methods The Randomized Controlled Trials（RCT） and Quasi-Randomized about TCM and MTX were collected by retrieved the CBM,CNKI and MEDLINE databases,and were systemically evaluated by systematic review method.Results There were 7 researches accorded with the internalized standard,all below 3 score used the Jadad Scoring Method.No one of these literatures was high-quality trial.The Meta-analysis were done for merging 3 data of these 7 researches,the result indicated that the effect of Zhengqing Fengtongning extended action tablet on decreased the number of the arthrocele,shorted stiffness time of RA patients and lowed the titre of rheumatoid factor（RF） was better than MTX,but the effect had no significant difference in decreased the number of joint tenderness and improved erythrocyte sedimentation rate（ESR）,which contrasted to MTX.Conclusion Because of the different treatment methods of RA,the few literature which can be merge to carry out Meta-analysis and the low methodology quality of the literature which is internalized and maybe have the publication bias,the availability and safety of RA treated by traditional Chinese medicine is pending to confirm with large sample,multicentic double-blind RCT,which must be designed strictly.