复方甘草酸苷与阿维A胶囊联合治疗银屑病疗效和安全性的系统评价

Effectiveness and Safety of Compound Glycyrrhizin Combined with Acitretin for Psoriasis: A Systematic Review

目的系统评价复方甘草酸苷联合阿维A胶囊对银屑病的治疗效果和安全性。方法计算机检索PubMed、e Cochrane Library、SpringerLink、CNKI、VIP、WanFang Data和CBM数据库,查找关于复方甘草酸苷联合阿维A胶囊与单纯阿维A胶囊比较治疗银屑病的随机对照试验。并手工检索《中国皮肤性病学杂志》、《中国麻风皮肤病杂志》等相关杂志,同时检索灰色文献,检索时限均为2000年1月至2012年3月。由2位研究者根据纳入标准独立筛选文献、提取资料并评价质量后,采用RevMan 5.0软件进行Meta分析。结果共纳入17个研究,共1 365例患者。Meta分析结果显示,复方甘草酸苷联合阿维A胶囊治疗方案优于单用阿维A胶囊的治疗方案,其中总有效率[OR=3.39,95%CI(2.55,4.52),P<0.000 01]、皮肤黏膜干燥发生率[OR=0.54,95%CI(0.30,0.98),P=0.04]、皮肤红斑发生率[OR=0.43,95%CI(0.24,0.76),P=0.004]、血AST、ALT升高发生率[OR=0.13,95%CI(0.04,0.41),P=0.000 5]和血脂升高发生率[OR=0.48,95%CI(0.30,0.77),P=0.002]差异均有统计学意义,但口唇干燥伴皲裂发生率[OR=0.50,95%CI(0.10,2.50),P=0.40]差异无统计学意义。漏斗图分析提示存在发表偏倚。结论复方甘草酸苷与阿维A胶囊联合治疗银屑病可明显提高其治愈率和有效率,减少皮肤黏膜干燥、皮肤红斑、血ALT、AST升高、血脂升高等不良反应发生率。受纳入研究质量和数量限制,上述结论尚需开展更多高质量研究加以验证。

Objective To assess the clinical effectiveness and safety of compound glycyrrhizin combined with acitretin for psoriasis. Methods The databases such as PubMed, The Cochrane Library, SpringerLink, CNKI, VIP, WanFang Data and CBM were searched to collect the randomized controlled trials （RCTs） about compound glycyrrhizin combined with acitretin vs. acitretin alone for psoriasis. Meanwhile, The Chinese Journal of Dermatovenereology, China Journal of Leprosy and Skin Diseases and the grey literature were also searched, qhe retrieval time was from January 2000 to March 2012. According to the Cochrane Reviewer＇s Handbook, two reviewers independently screened the literature, extracted the data and assessed the methodological quality of the included studies. Then the meta-analysis was performed using RevManS.0 software. Results A total of 17 RCTs involving l 365 patients were included. The results of meta- analysis showed that, the regimen of compound glycyrrbizin combined with acitretin was superior to acitretin alone; there were significant differences in the total effective rate （OR=3.39, 95%CI 2.55 to 4.52, P〈0.000 01） and in the incidence of skin and mucous membrane dryness （OR=0.54, 95%CI 0.32 to 0.98, P=0.04）, skin erythema （OR=0.43, 95% CI 0.24 to 0.76, P=0.004）, elevated AST and ALT （OR=0.13, 95%CI 0.04 to 0.41, P=0.000 5） and elevated blood lipid （OR=0.48, 95%CI 0.30 to 0.77, P=0.002）. But no significant difference was found in the incidence of dry and cracked lips （OR=0.50, 95%CI 0.10 to 2.50, P=0.40）. There was publication bias shown by funnel plot analysis. Conclusion The compound glycyrrhizin combined with acitretin for psoriasis can obviously increase the cure rate and effective rate, and reduce the incidence of adverse reaction, such as dryness of skin and mucous membrane, skin erythema, elevated AST and ALT, and elevated blood lipid. For the limitation of quality and quantity of included studies, this conclusion still needs to be proved by conducting more high quality researches.