经方辨证对比抗组胺药治疗湿疹有效性和安全性的Meta分析

Meta-analysis of Effectiveness and Safety of Classical Prescription versus Antihistamines in the Treatment of Eczema

目的:系统评价经方辨证对比抗组胺药治疗湿疹的有效性和安全性。方法:计算机检索中国生物医学文献光盘数据库、中国期刊全文数据库,收集经方辨证(试验组)对比抗组胺药(对照组)治疗湿疹的随机对照试验(RCT)。筛选文献、提取资料后采用改良Jadad量表对纳入文献质量进行评价,采用Rev Man 5.3软件进行Meta分析。结果:共纳入19项RCT,共计1829例患者。Meta分析结果显示,试验组湿热蕴肤型[OR=5.67,95%CI(3.44,9.33),P<0.00001]、脾虚湿蕴型[OR=4.23,95%CI(1.89,9.46),P=0.0004]、血虚风燥型[OR=3.57,95%CI(2.36,5.41),P<0.00001]患者总有效率均显著高于对照组。试验组湿热蕴肤型[OR=0.72,95%CI(0.21,2.41),P=0.59]、脾虚湿蕴型[OR=0.31,95%CI(0.01,13.57),P=0.54]、血虚风燥型[OR=1.08,95%CI(0.18,6.59),P=0.93]患者不良反应发生率与对照组比较,差异均无统计学意义。治疗后,试验组湿热蕴肤型患者肿瘤坏死因子α[SMD=-1.67,95%CI(-2.04,-1.31),P<0.00001]、白细胞介素6[SMD=-1.53,95%CI(-1.88,-1.17),P<0.00001]、白细胞介素8[SMD=-1.75,95%CI(-2.28,-1.21),P<0.00001]水平均显著低于对照组;CD4+水平[SMD=1.51,95%CI(-0.37,3.38),P=0.12]与对照组比较,差异无统计学意义。结论:经方辨证治疗湿疹的效果显著优于抗组胺药治疗,且安全性相当;龙胆泻肝汤加减可显著降低湿热蕴肤型患者的炎症因子水平。

OBJECTIVE:To systematically evaluate the effectiveness and safety of classical prescription versus antihistamines in the treatment of eczema.METHODS:Retrieved from CBM and CNKI,randomized controlled trials(RCTs)about classical prescription(trial group)versus antihistamines(control group)in the treatment of eczema were collected.The qualities of included literatures were evaluated by modified Jadad scale after literature screening and data extraction,and Meta-analysis was performed by using Rev Man 5.3 software.RESULTS:Totally 19 RCTs involving 1829 patients were included.Meta-analysis showed that total response rate of patients with Shire Yunfu type[OR=5.67,95%CI(3.44,9.33),P<0.00001],Pixu Shiyun type[OR=4.23,95%CI(1.89,9.46),P=0.0004],Xuexu Fengzao type[OR=3.57,95%CI(2.36,5.41),P<0.00001]in trial group were significantly higher than that of control group.There were no statistical differences in the incidence of ADR between patients with Shire Yunfu type[OR=0.72,95%CI(0.21,2.41),P=0.59],Pixu Shiyun type[OR=0.31,95%CI(0.01,13.57),P=0.54],Xuexu Fengzao type[OR=1.08,95%CI(0.18,6.59),P=0.93]in trial group and control group.After treatment,the levels of TNF-α[SMD=-1.67,95%CI(-2.04,-1.31),P<0.00001],IL-6[SMD=-1.53,95%CI(-1.88,-1.17),P<0.00001]and IL-8[SMD=-1.75,95%CI(-2.28,-1.21),P<0.00001]in patients with Shire Yunfu type in trial group were significantly lower than control group.There was no statistical significance in CD4+levels[SMD=1.51,95%CI(-0.37,3.38),P=0.12]between Shire Yunfu type patients in trial group and control group.CONCLUSIONS:Therapeutic efficacy of classical prescription in treatment of eczema is better than antihistamines,with similar safety.Modified Longdan xiegan decoction can significantly reduce the levels of inflammatory cytokines in patients with Shire Yunfu type.