中医药治疗强直性脊柱炎疗效的Meta分析

Meta-analysis of Curative Effect of TCM on Ankylosing Spondylitis

目的:系统评价中医药治疗强直性脊柱炎的临床疗效。方法:计算机检索中国知网(CNKI)、万方数据库、香港文学资料库、台湾学术期刊在线数据库、Cochrane library、PubMed数据库,纳入2014年至2018年中医药治疗强直性脊柱炎的随机对照研究文献,使用RevMan5.3统计软件对资料进行Meta分析。结果:最终纳入8篇随机对照研究,其中7篇为中文文献,1篇为英文文献,共674例强直性脊柱炎患者。Meta分析结果显示,中医药治疗强直性脊柱炎可降低Bath强直性脊柱炎活动指数(BASDAI)(MD=-3.53,95%CI=[-5.08,-1.97])、Bath强直性脊柱炎功能指数(BASFI)(MD=-1.85,95%CI=[-2.46,-1.24])、C-反应蛋白(CRP)(MD=-5.49,95%CI=[-7.71,-3.26])和红细胞沉降率(ESR)(MD=-5.52,95%CI=[-8.69,-2.35]);还可改善患者脊柱痛(MD=-1.73,95%CI=[-2.13,-1.33])和枕墙距(MD=-0.36,95%CI=[-0.48,-0.23]);但在改善患者指地距(MD=-5.17,95%CI=[-10.52,0.18])和胸廓活动度(MD=0.17,95%CI=[-0.17,0.50])方面,差异无统计学意义;治疗组患者总体评价(PGA)(MD=-0.90,95%CI=[-1.33,-0.47])和临床总有效率(MD=5.17,95%CI=[2.98,8.96])与对照组比较,差异有统计学意义。结论:中医药治疗强直性脊柱炎能够降低炎症反应,改善患者BASDAI、BASFI、脊柱痛、枕墙距和PGA,在治疗强直性脊柱炎的总体疗效上要优于单纯西药治疗,且不良反应少,但在改善患者指地距和胸廓活动度上无明显优势。

Objective:To systematically evaluate the clinical efficacy of TCM in the treatment of ankylosing spondylitis.Methods:The randomized controlled literature of TCM treatment of ankylosing spondylitis from 2014 to 2018 was retrieved by computer from CNKI,Wanfang database,Hong Kong literature database,online database of Taiwan academic journals,Cochrane library and PubMed database.RevMan 5.3 statistical software was used to make a meta-analysis for the data.Results:Eight randomized controlled studies were included,including one in English and seven in Chinese.There are a total of 674 patients with ankylosing spondylitis.Meta-analysis showed that the treatment of ankylosing spondylitis with TCM could reduce BASDAI (MD =-3.53,95%CI =[-5.08,-1.97]),BASFI(MD =-1.85,95%CI =[-2.46,-1.24]),CRP (MD =-5.49,95%CI =[-7.71,-3.26])and ESR(MD =-5.52,95%CI =[-8.69,-2.35]),and improve spinal pain(MD =-1.73,95% CI =[-2.13,-1.33])and occipital wall distance(MD =-0.36,95%CI =[-0.48,-0.23]),but there was no significant difference in the improvement of finger-to-ground distance(MD =-5.17,95%CI =[-10.52,0.18])and thoracic activity(MD = 0.17,95%CI =[-0.17,0.50]).There was a statistical significance of PGA(MD =-0.90,95%CI =[-1.33,-0.47])and the total clinical efficacy(MD = 5.17,95%CI =[2.98,8.96])between the two groups.Conclusion:Treating ankylosing spondylitis with TCM can reduce inflammation,improve BASDAI,BASFI,spinal pain,occipital wall distance and PGA in patients with ankylosing spondylitis.The overall efficacy is better than that with Western medicine alone,with fewer adverse reactions,but there is no obvious advantage in improving finger-to-ground distance and chest mobility.