雷公藤治疗类风湿关节炎生殖系统不良事件发生率的meta分析

Meta-analysis of the incidence of reproductive adverse events in the treatment of rheumatoid arthritis by Tripterygium wilfordii

目的系统评价雷公藤治疗类风湿关节炎患者生殖毒性不良反应。方法检索PubMed、EMbase、Cochrane Library、Web of Science、CNKI、CBM、万方、维普等数据库,从建库至2020年1月所有雷公藤治疗类风湿关节炎的随机对照试验,检索关键词“雷公藤多苷”“雷公藤多甙”“雷公藤”“类风湿关节炎”“类风湿性关节炎”“痹证”“痹病”。针对出现生殖系统毒性不良反应的文献,使用Jadad量表评分,并采用软件RevMan5.3对其生殖系统毒性的发生率进行分析。结果共检索并分析1454篇文献,经过筛选,其中22篇文献符合纳入标准,累计样本量2085例,实验组(雷公藤)924例,对照组(非雷公藤)1161例。与对照组比较,实验组月经不调、闭经和精子活力下降发生率升高(RR=4.58,95%CI:2.65~7.92,P<0.00001;RR=4.97,95%CI:1.81~13.63,P=0.002;RR=11.02,95%CI:2.73~44.44,P=0.0007)。结论患者使用雷公藤在一定程度上会出现生殖系统的毒副作用,在临床用药应注意防治。但由于可纳入文献有限,上述结果还需更高质量的随机对照试验研究进一步验证。

Objective To systematic evaluate reproductive toxicity adverse of Tripterygium wilfordii in the treatment of patients with rheumatoid arthritis.Methods PubMed,EMbase,Cochrane Library,Web of Science,CNKI,CBM,Wanfang,VIP and other databases were searched.From the establishment of the database to January 2020,all randomized controlled trials of Tripterygium wilfordii in the treatment of rheumatoid arthritis were searched for the key words of“Tripterygium wilfordii multiglucoside”,“Tripterygium wilfordii polyglycoside”,“Tripterygium wilfordii”,“rheumatoid arthritis”,“rheumatoid arthritis”,“arthralgia syndrome”and“arthralgia”.According to the literature of reproductive toxicity,Jadad scale was used to score and RevMan5.3 software was used to analyze the incidence of reproductive toxicity.Results A total of 1454 articles were searched and analyzed.Twenty-two of them met the inclusion criteria.Total sample size was 2085 cases,including 924 cases in experimental group(Tripterygium wilfordii)and 1161 cases in control group(non Tripterygium wilfordii).Compared with control group,the incidence of menstrual disorder,amenorrhea and sperm motility decreased in experimental group increased(RR=4.58,95%CI:2.65-7.92,P<0.00001;RR=4.97,95%CI:1.81-13.63,P=0.002;RR=11.02,95%CI:2.73-44.44,P=0.0007).Conclusion The side effects of reproductive system toxicity will appear in patients using Tripterygium wilfordii to a certain extent.However,due to the limited literature available,the above results need to be further verified by higher quality randomized controlled trials.