中医药治疗重症肌无力系统评价的再评价

Traditional Chinese Medicine for Myasthenia Gravis:An Overview of Systematic Reviews

目的对中医药治疗重症肌无力(myasthenia gravis,MG)的系统评价进行再评价研究。方法计算机检索PubMed、EMbase、The Cochrane Library(2018年11期)、CBM、CNKI、万方等6个数据库,检索时限均为从建库至2018年11月20日。采用AMSTAR工具评价纳入系统评价的方法学质量,并应用GRADE证据评价工具进行证据质量分级。结果共纳入相关系统评价或Meta分析9篇,包含42个结局指标。方法学质量评价结果显示,所纳入9篇系统评价的首要问题是均未提供前期设计方案,其次是未说明相关利益冲突(7篇)。证据质量分级结果显示,在42个结局指标中,极低质量11个,低质量27个,中等质量仅4个,导致降级最主要因素为局限性(42个结局指标),其次为不精确(19个结局指标)和不一致(18个结局指标)。结论基于系统评价再评价结果,中草药治疗MG具有一定疗效和安全性,针灸治疗MG的系统评价文献数量较少,鉴于二者均存在方法学质量总体较差、证据等级总体偏低,该研究结论存在一定局限性,临床医师在使用这些证据进行临床决策时尚需谨慎。建议今后进一步加强原始研究顶层设计科学性和报告规范性,同时更多关注中草药联合针灸治疗MG的综合效应的系统评价研究。

Objective To evaluate the methodological bias and the reliability of the conclusions of systematic reviews(SRs)about traditional Chinese medicine for myasthenia gravis.Methods We comprehensively searched PubMed,EMbase,The Cochrane library(Issue 11,2018),CBM,CNKI and WanFang Data to collect SRs of traditional Chinese medicine for myasthenia gravis from the establishment time of databases to November 20 th,2018.The AMSTAR tool was applied for methodological quality assessment of included studies,and the GRADE system was applied for evidence quality assessment of included outcomes of SRs.Results A total of 9 SRs involving 42 outcomes were included.The results of assessment using AMSTAR showed that among 11 items,there were the most problems concerning Item 1"Was an′a prior′design provided?"(none of the 9 SRs provided it);followed by Item 11"Were potential conflict of interest included?"(7 SRs did not described it).The results of grading showed that,11 outcomes were graded as"low"quality,27 outcomes were graded as"very low"quality,only 4 outcomes were graded as"moderate quality".The main factors contributed to downgrading evidence quality were limitations(42 outcomes),followed by imprecision(19 outcomes),and inconsistency(18 outcomes).Conclusion Based on the results of systematic evaluation and reevaluation,TCM has a certain curative effect on the treatment of myasthenia gravis.In view of the current moderate methodological quality of TCM treatment for myasthenia gravis and the impact of systematic evaluation and reevaluation process,this study has certain limitations.Therefore,the strength of the evidence currently supported needs to be further improved in order to provide clinicians with more advanced clinical evidence.