青蒿鳖甲汤化裁治疗阴虚型系统性红斑狼疮增效减毒的Meta分析

Meta-analysis of Efficacy-enhancing and Toxicity-reducing of Modified Qinghao Biejia Tang(青蒿鳖甲汤)in the Treatment of Yin-deficiency-type Systemic Lupus Erythematosus

目的:系统性评价以青蒿鳖甲汤化裁联合常规西药治疗阴虚型系统性红斑狼疮(SLE)的增效减毒作用。方法:计算机检索中国知网(CNKI)、维普(VIP)、万方(Wanfang)、PubMed、Cochrane Library等数据库,查找青蒿鳖甲汤化裁联合常规西药治疗SLE的临床随机对照试验文献,检索时间为数据库建立至2019年8月。摘录纳入文献的原始资料,进行质量评价后使用RevMan 5.3软件进行Meta分析。结果:最终纳入15篇文献,共980例患者,其中试验组501例,对照组479例。Meta分析结果显示,青蒿鳖甲汤化裁联合常规西药治疗阴虚型SLE的总有效率高于对照组(RR=5.07,95%CI=[3.35,7.65],P<0.00001);在改善SLE疾病活动度评分(SMD=-1.65,95%CI=[-1.89,-1.40],P<0.00001)、中医证候评分(SMD=-3.28,95%CI=[-3.99,-2.57],P<0.00001)、补体C3(SMD=0.15,95%CI=[0.05,0.24],P=0.002)、补体C4(SMD=0.04,95%CI=[0.02,0.06],P<0.0006)及抗ds-DNA抗体转阴率(SMD=2.39,95%CI=[1.21,4.75],P=0.01)等方面均较对照组疗效更佳;在降低泼尼松用量(SMD=-3.75,95%CI=[-4.51,-3.00],P<0.00001)、不良反应发生率(RR=0.24,95%CI=[0.13,0.43],P<0.00001)方面较对照组更有优势。结论:青蒿鳖甲汤化裁联合常规西药治疗阴虚型SLE在增效减毒方面较西药更具优势。

Objective:To systematically evaluate the efficacy-enhancing and toxicity-reducing ofQinghao Biejia Tang(青蒿鳖甲汤)combined with western medicine in the treatment of yin-deficiency-type systemic lupus erythematosus(SLE).Methods:CNKI,VIP,Wanfang,PubMed,Cochrane Library and other databases were searched for randomized controlled clinical literature(from the establishment of the database to August 2019)of Qinghao Biejia Tang combined with western medicine in the treatment of SLE.Meta-analysis was performed using software RevMan 5.3 after quality evaluation.Results:A total of 980 patients were included in 15 articles,including501 cases in the treatment group and 479 cases in the control group.The results of meta-analysis showed that the total effective rate of Qinghao Biejia Tang combined with conventional western medicine was higher than that of Western medicinealone(RR=5.07,95%CI=[3.35,7.65],P<0.00001),whose curative effect was better than that in the control group on the aspects of improving SLE disease activity score(SMD=-1.65,95%CI=[-1.89,-1.40],P<0.00001),TCM syndrome score(SMD=-3.28,95%CI=[-3.99,-2.57],P<0.00001),complement C3(SMD=0.15,95%CI=[0.05,0.24],P=0.002),complement C4(SMD=0.04,95%CI=[0.02,0.06],P<0.0006)and the negative conversion rate of anti ds-DNA antibody(SMD=2.39,95%CI=[1.21,4.75],P=0.01),and reducing the dosage of prednisone(SMD=-3.75,95%CI=[-4.51,-3.00],P<0.00001)and incidence of adverse reactions(RR=0.24,95%CI=[0.13,0.43],P<0.00001).Conclusion:Modified Qinghao Biejia Tang combined with western medicine in the treatment of yin-deficiency-type SLE has more advantages than western medicine.