小剂量糖皮质激素抑制类风湿关节炎放射学进展的系统评价

Low dose glucocorticoids for inhibiting radiological progression in rheumatoid arthritis： a systematic review

目的系统评价小剂量糖皮质激素抑制类风湿关节炎（RA）放射学进展的疗效。方法计算机检索Medline（1966年1月至2010年4月）、Embase（1966年至2010年4月）、Cochrane图书馆（2010年第2期）、中国生物医学数据库、中国期刊全文数据库（CNKI）、万方及维普数据库（1979年1月至2010年4月），并检索所纳人文献的参考文献。收集所有相关随机对照试验，采用Cochrane协作网提供的软件Revman5进行Meta分析，以获得小剂量糖皮质激素抑制RA放射学进展的相关证据。结果经全面检索及筛查后，共纳入11个随机对照试验进行评价。Meta分析表明，在用药1年后，骨与关节侵蚀的标准化均数差（SMD）是-0．39195％CI（-0．50～0．27）]。2年时，侵蚀的SMD是-0．73195％CI（-1．29—0．16）]。结论小剂量糖皮质激素能减缓RA放射学病损的进展。

Objectives To evaluate the inhibitory effect of low close glucocortieoid on progression of radialogical damage in rheumatoid arthritis by systematic review. Methods A search of MEDLINE （from 1966 to April 2010）, Embase （from 1966 to April 2010）, Cochrane Library （2 Issue, 2010）, CBM disc, CNKI, WANFANG and VIP Database was undertaken to collect randomized controlled trials published before April 2010 based on the Coehrane Collaboration recommendations. Additional reports were identified from the reference lists. Statistical analysis was performed with RevMan 5.0 software. Results Eleven studies that met the inclusion criteria, in which 1395 patients, were included. Meta-analysis showed that the standardised mean difference in progression was 0.40 （95%CI 0.27~0.54） in favour of glucoeortieoids over the first year. In studies that lasted for 2 years, the standardised mean difference in progression in favour of glueocortieoids at 1 year was -0.39195%CI（-0.50^-0.27）] and was -0.73195%CI（-1.29^-0.16）] at 2 years. All studies except one showed benefit of glucocorticoids treatment. Conclusions The results of this study has shown that low dose glueoeortieoids can substantially reduce the progression rate of erosion in rheumatoid arthritis.