雷公藤多苷片治疗类风湿关节炎作用于IL-23/IL-17轴相关细胞因子的系统评价和meta分析

Systematic review and meta-analysis of the effect of Tripterygium Glycoside Tablets on IL-23/IL-17 axis related cytokines in the treatment of rheumatoid arthritis

目的评价雷公藤多苷片在治疗类风湿关节炎(RA)中对白细胞介素(IL)-23/IL-17炎症轴相关的促炎细胞因子和抑炎细胞因子表达水平的作用。方法检索中国知网、维普、万方、SinoMed、EMbase、PubMed、Clinical Trials、Web of Science、Cochrane Library等中英文数据库,检索时限为该数据库建立至2019年12月22日,纳入雷公藤多苷片治疗RA的随机对照试验(RCT)并进行资料提取,采用Cochrane协作网推荐的"偏倚风险"评估工具进行方法学质量评价,采用RevMan 5.3软件进行meta分析。结果与单用甲氨喋呤组比较,雷公藤多苷联合甲氨喋呤或来氟米特显著降低IL-1、IL-6、肿瘤坏死因子-α水平,差异有统计学意义(P <0.05);与单用甲氨喋呤或来氟米特比较,雷公藤多苷片联合甲氨喋呤或来氟米特对IL-10的影响,差异无统计学意义(P> 0.05)。结论雷公藤多苷片联合甲氨喋呤或来氟米特可以显著降低IL-23/IL-17轴相关促炎细胞因子的表达水平。但极少数RCT报告了雷公藤多苷片对于抑炎细胞因子的作用,现有证据尚不能得出雷公藤多苷片能提高抑炎细胞因子水平的结论。

Objective To evaluate the effect of Tripterygium Glycoside Tablets on the expression of pro-inflammatory cytokines and anti-inflammatory cytokines related to interleukin(IL)-23/IL-17 inflammatory axis in rheumatoid arthritis(RA) treatment. Methods Search through Chinese and English databases such as CNKI, VIP,WanFang, SinoMed, EMbase, PubMed, Clinical Trials,Web of Science, Cochrane Library, etc. With a period of time from the establishment of the databases to December 22, 2019. Randomized controlled trials(RCT) of Tripterygium Glycoside Tablets for RA were included,from which the data was extracted. Methodological quality evaluation was performed using the "bias risk" assessment tool recommended by Cochrane Collaboration, and RevMan 5.3 software was used for meta-analysis. Results Compared with using Methotrexate alone, Tripterygium Glycoside Tablets combined with Methotrexate had an advantage in reducing the levels of IL-1, IL-6 and tumor necrosis factor-α, the difference were statistically significant(P < 0.05). While in comparison with using Methotrexate or Leflunomide alone, Tripterygium Glycoside Tablets combined with Methotrexate or Leflunomide had shown no statistically marked difference regarding the effect on IL-10(P > 0.05). Conclusion Tripterygium Glycoside Tablets combined with Methotrexate or Leflunomide can significantly reduce the expression of IL-23/IL-17 axis related to pro-inflammatory cytokines. However, there are rare RCTs that have reported the effect of Tripterygium Glycoside Tablets on anti-inflammatory cytokines, and the existing evidence can not reach the conclusion that Tripterygium Glycoside Tablets can improve the level of anti-inflammatory cytokines.