雷公藤多苷(甙)片单用或联合甲氨蝶呤对类风湿关节炎临床表现改善作用的Meta分析

Clinical symptoms effect of Tripterygium Glycosides Tablets alone or combined with methotrexate in treatment of rheumatoid arthritis: a Meta-analysis

系统评价雷公藤多苷(甙)片(TGT)单用或联合甲氨蝶呤(MTX)对类风湿关节炎(RA)临床症状和体征的改善作用,为TGT的临床合理用药提供依据。该研究通过系统检索了CNKI、万方、维普、PubMed、EMbase、Cochrane Library 6个文献数据库,根据纳入及排除标准,应用RevMan 5.3软件将文献录入,对每篇纳入的文献进行结局指标水平的风险偏倚评估。共纳入18篇文献,分类结果显示:单独用药方面,对比MTX,TGT单独用药减少RA患者的关节肿胀数(MD=0.18,95%CI[-1.06,1.42],P=0.78)、关节压痛数(MD=-0.06,95%CI[-1.69,1.56],P=0.94)与MTX的作用相当;联合用药方面,TGT联合MTX比MTX单独使用对减少RA晨僵时间(MD=18.24,95%CI[12.64,23.84],P<0.000 01)、关节压痛数(MD=2.65,95%CI[1.85,3.44],P<0.000 01)和关节肿胀数(MD=3.01,95%CI[2.09,3.93],P<0.000 01)具有优势。现有临床证据表明TGT单独用药对RA患者的关节压痛数和关节肿胀数改善作用与MTX相当,TGT联合MTX对RA患者临床表现的改善优于MTX单独使用。

To systematically review the improvement effects of Tripterygium Glycosides Tables(TGT)alone or in combination with methotrexate(MTX)on the clinical signs and symptoms of rheumatoid arthritis(RA),and provide a basis for the rational use of TGT in clinic,in the current study,six literature databases including CNKI,WanFang,VIP,PubMed,EMbase,and Cochrane Library,were systematically searched,according to the inclusion and exclusion criteria.Review Manager 5.3 software was used to input the liter-atures,and we assessed the risk bias on the level of outcome indicators for each included literature.A total of 18 literatures were in-cluded,and the classification results showed that:compared with MTX,TGT alone can reduce the number of joint swelling(MD=0.18,95%CI[-1.06,1.42],P=0.78)and joint tenderness(MD=-0.06,95%CI[-1.69,1.56],P=0.94)in RA patients with the same effect as MTX.In terms of drug combination,TGT combined with MTX had an advantage over MTX alone in lessening the morning stiffness time(MD=18.24,95%CI[12.64,23.84],P<0.000 01)of RA,joint tenderness(MD=2.65,95%CI[1.85,3.44],P<0.000 01)and joint swelling(MD=3.01,95%CI[2.09,3.39],P<0.000 01).In conclusion,this Meta-analysis suggest that TGT alone was superior to MTX in improving joint swelling and tenderness in RA patients,TGT combined with MTX may improve the clinical manifestation of RA patients better than MTX alone.