中药汤剂对急性痛风性关节炎疗效及安全性的Meta分析

Meta-analysis of effect and safety of Chinese medical herbs decoction on acute gouty arthritis

目的:评价中药汤剂与秋水仙碱对急性痛风性关节炎患者治疗的临床疗效及安全性。方法:计算机检索中国知网、维普中文、万方数据,查找筛选中药对比秋水仙碱治疗急性痛风性关节炎的随机对照临床试验文献,并采用改良Jadad量表法进行质量评估,用RevMan 5.3软件对数据进行分析。结果:共纳入RCT文献15篇,受试者共1109例。结果:Meta分析结果显示,中药组相对于秋水仙碱组在总有效率[OR=2.18,95%CI(1.44,3.28),P﹤0.01],降低尿酸[SMD=-85.12.00,95%CI(-117.73,-52.51),P﹤0.01]、超敏C反应蛋白[SMD=-2.45,95%CI(-4.14,-0.75),P﹤0.01]水平方面有统计学差异;而在对血沉[SMD=-4.64,95%CI(-10.32,1.05),P=0.11]、疼痛评分[SMD=-0.45,95%CI(-0.95,0.05),P=0.08]、白细胞[SMD=-0.63,95%CI(-1.60,0.34),P=0.20]、谷丙转氨酶[SMD=-4.93,95%CI(-13.28,3.41),P=0.25]、肌酐[SMD=-1.93,95%CI(-5.14,0.14),P=0.24]的影响方面无统计学差异。共有10篇文献有记录不良反应数据,其中中药组共有340例,不良反应9例(2.65%);秋水仙碱组患者338例,不良反应129例(38.17%)。结论:中药在AGA的治疗以及对降低患者尿酸水平方面较秋水仙碱更佳,并且更为安全。

Objective:To evaluate the clinical effects and safety of Chinese medical herbs decoction and colchicine on acute gouty arthritis.Methods:CNKI,WanFang Data and VIP were retrieved by computer.The randomized controlled clinical trials of treating AGA by contrasting Chinese medical herbs with colchicine were searched and screened.The quality was evaluated by modified Jadad scale.The data were analyzed by RevMan 5.3 software.Results:A total of 15 RCTs were included.1109 cases of subjects were concluded in total.Meta analysis results showed as follows,compared with colchicine group,the total effective rate of Chinese medical herbs group on AGA was[OR=2.18,95%CI(1.44,3.28),P﹤0.01],in reduction of uric acid[SMD=-85.12.00,95%CI(-117.73,-52.51),P﹤0.01],in C-reactive protein[SMD=-2.45,95%CI(-4.14,-0.75),P﹤0.01],and there was statistical difference;but in erythrocyte sedimentation rate[SMD=-4.64,95%CI(-10.32,-1.05),P=0.11],in visual pain score[SMD=-0.45,95%CI(-0.95,0.05),P=0.08],in white blood cell[SMD=-0.63,95%CI(-1.60,0.34),P=0.20],in alanine aminotransferase[SMD=-4.93,95%CI(-13.28,3.41),P=0.25],in creatinine[SMD=-1.93,95%CI(-5.14,0.14),P=0.24],there was no statistical difference.A total of 10 RCTs have recorded adverse reactions data,i.e.among a total of 340 cases of Chinese medical herbs group,9 cases had ADR(2.65%);amnong 338 cases of colchicine group,129 cases had ADR(38.17%).Conclusion:Chinese medical herbs is better and safer than colchicine in treatment of AGA and reduction of uric acid level.