摘要
评估肿瘤坏死因子(TNF)抑制剂和非甾体抗炎药(NSAIDs)治疗强直性脊柱炎(AS)的疗效。检索并纳入2014年7月前TNF抑制剂或NSAIDs治疗AS且与安慰剂对照的随机对照试验。共纳入17篇研究,其中12篇评估TNF抑制剂,5篇评估NSAIDs。Meta分析结果显示:在"疼痛"和"患者总体评估"方面,治疗效果在TNF抑制剂组和NSAIDs组是中等或者大。在"机体功能"方面,TNF抑制剂组治疗效果是大,NSAIDs组是小。在"急性时相反应物"方面,TNF抑制剂组效应量是中等的,而NSAIDs对"急性时相反应物"无显著影响。在"脊柱活动度"方面,NSAIDs的疗效无统计学意义。不同方面很难比较TNF抑制剂和NSAIDs的疗效,但TNF抑制剂较NSAIDs在改善患者机体功能、降低炎症反应方面更有效。TNF抑制剂是否有改善病情作用及与NSAIDs药物如何联合延缓AS结构破坏,仍需高质量、大样本、长期的临床试验来验证。
To evaluate the efficacy of TNF blockers and anti‐inflammatory agents （NSAIDs） in the treatment of ankylosing spondylitis （AS ） . We perform a meta‐analysis of randomised controlled trials （RCTs ） of TNF blockers and anti‐inflammatory agents （NSAIDs） in patients with ankylosing spondylitis reported up to July ,2014 .Altogether ,17 articles were included in the analysis ,12 selected RCTs evaluating anti‐TNF ,and 5 evaluating NSAIDs RCTs .For the domains pain and patient＇s global assessment ,the treatment effect was large or medium for both TNF blockers and NSAIDs .For the domain physical function ,the effect of TNF blockers was large and NSAIDs on physical function is medium .For the domain acute‐phase reactants ,the effect of TNF blockers was medium ,whereas NSAIDs had no significant effect on acute‐phase reactants .Finally ,for the domain mobility ,the effect size of NSAIDs was small and not significant .The results suggests that it is difficult to campare the efficacy of TNF blockers and NSAIDs in different domains ,but TNF blockers are more effective in improving physical function and decreasing the inflammatory parameters compared with NSAIDs . More high quality ,large sample ,long‐term clinical trial are required to demonstrate the disease‐modifing effect of TNF blockers and how to combined TNF blockers and NSAIDs in improving structural progression in AS .
出处
《医学与哲学（B）》
2015年第4期37-42,共6页
Medicine & Philosophy(B)
