雷公藤与阿维A治疗寻常型银屑病的系统评价

Systematic review and Meta-analysis of tripterygium wilfordii hook F and acitretin on the randomized controlled trial for treatment of psoriasis vulgaris

目的Meta分析雷公藤与阿维A单独或联合治疗寻常型银屑病的疗效和安全性。方法计算机检索Pubmed、Cochrane、中国知网、万方医学网等数据库,收集雷公藤单独或联合阿维A治疗寻常型银屑病的疗效和安全性的随机对照试验。结局指标以银屑病皮损面积和严重性指数评分(PASI)表示,分别比较显效率(PASI评分改善60%~89%)、基本痊愈率(PASI评分改善90%~100%)、药物不良反应差异。对符合纳入标准的临床研究进行资料提取和质量评价,采用Revman5.3软件进行Meta分析。结果共纳入13项研究,1258例患者。雷公藤(n=284)与阿维A单药(n=273)相比,显效率(RR=1.08,95%CI:0.79~1.47,P=0.65)和基本痊愈率(RR=1.22,95%CI:0.67~2.22,P=0.52)差异均无统计学意义。雷公藤联合阿维A(n=368)与阿维A单药(n=365)相比,联合组显效率(RR=1.48,95%CI:1.33~1.64,P<0.01)和基本痊愈率(RR=1.44,95%CI:1.19~1.75,P<0.01)均优于阿维A单药组。联合组与阿维A单药比较,胃肠不适(RR=0.54,95%CI:0.33~0.91,P<0.05)、肝功能异常(RR=0.37,95%CI:0.18~0.78,P<0.05)均减少,皮肤黏膜干燥(RR=0.66,95%CI:0.34~1.27,P=0.21)、血脂升高(RR=0.59,95%CI:0.31~1.11,P=0.10)差异无统计学意义。结论雷公藤可有效治疗寻常型银屑病,雷公藤联合阿维A治疗寻常型银屑病效果优于阿维A单药。

Objective To analyze the efficacy and safety of tripterygium wilfordii hook F(TwHF)alone or combination with acitretin in the treatment of psoriasis vulgaris,and provide evidence-based reference for clinical treatment.Methods Pubmed,Cochrane,CNKI and Wanfang database were searched up to December 2018.Data of the randomized controlled trial(RCT)of TwHF alone or in combination with acitretin for psoriasis vulgaris were collected.The primary end-point was the proportions of patients achieved 60%to 89%,and 90%to 100%improvement in psoriasis area and severity index(PASI)respectively,which were considered as effective rate and cure rate.Adverse drug reactions were analyzed.A systematic review and meta-analysis were conducted for extracted data and quality evaluation by Rev Man 5.3 software.Results A total of 1258 patients from 13 clinical trials were included in this study.There were no statistically significant differences in effective rate(RR=1.08,95%CI:0.79-1.47,P=0.65)and cure rate(RR=1.22,95%CI:0.67-2.22,P=0.52)between TwHF group(n=284)and acitretin group(n=273).The effective rate(RR=1.48,95%CI:1.33-1.64,P<0.01)and cure rate(RR=1.44,95%CI:1.19-1.75,P<0.01)were better in TwHF and acitretin combination group(n=368)than those of acitretin group(n=365).Compared with acitretin group,the incidence of gastrointestinal reactions(RR=0.54,95%CI:0.33-0.91,P<0.05)and abnormal liver function(RR=0.37,95%CI:0.18-0.78,P<0.05)were decreased in the combined group.There were no significant differences in dry skin or mucosa(RR=0.66,95%CI:0.34-1.27,P=0.21)and elevated blood lipid(RR=0.59,95%CI:0.31-1.11,P=0.10).Conclusion TwHF can effectively treat psoriasis vulgaris.TwHF combined with acitretin is superior to acitretin monotherapy in the treatment of psoriasis vulgaris.