清热凉血法治疗银屑病临床疗效及对炎症细胞因子影响的Meta分析

Meta-analysis of clinical effect of clearing heat and cooling blood on psoriasis and its effect on inflammatory cytokines

目的:评价清热凉血法与阿维A比较对银屑病临床疗效及血清炎症细胞因子的影响。方法:计算机检索中英文各大数据库,检索时间自建库至2019年12月。根据纳入及排除标准筛选文献,提取资料,采用风险评估工具进行质量评价,使用Revman 5.3软件对纳入文献的结局指标进行Meta分析。结果:最终纳入20项研究,共计1592例患者。分析结果显示:清热凉血法单用或联合阿维A治疗银屑病在总有效率[OR=3.70,95%CI(2.58,5.30),P<0.00001]、治愈率[OR=2.40,95%CI(1.86,3.10),P<0.00001]、PASI评分[MD=-2.65,95%CI(-3.60,-1.70),P<0.00001]、炎症细胞因子[MD=-8.84,95%CI(-10.52,-7.16),P<0.00001]、不良反应[OR=0.25,95%CI(0.11,0.57),P=0.001]方面均优于阿维A。统计临床使用频次居前10位的中药,依次是生地、赤芍、丹皮、金银花、紫草、土茯苓、丹参、水牛角、鸡血藤、当归。结论:基于目前证据,对于银屑病的治疗以清热凉血类为主的中药单用或联合阿维A能更好提高疗效,其机制可能与减轻炎症反应相关。因纳入文献的限制,该结论还有待进一步验证。

Objective:To evaluate the effect of clearing heat and cooling blood on clinical efficacy of psoriasis and serum inflammatory cytokines compared with Acitretin Capsules.Methods:Computer retrieval of major Chinese and English databases was done with retrieval time until December 2019.According to the criteria for screening and selection of studies,data were screened,extracted and evaluated by risk assessment tools.A meta-analysis was performed using Revman 5.3 software for the outcome indicators of the included studies.Results:A total of 20 studies were included,with a total of 1592 patients.The analysis results showed that the total effective rate[OR=3.70,95%CI(2.58,5.30),P<0.00001],cure rate[OR=2.40,95%CI(1.86,3.10),P<0.00001],PASI score[MD=-2.65,95%CI(-3.60,-1.70),P<0.00001],serum inflammatory cytokines[MD=-8.84,95%CI(-10.52,-7.16),P<0.00001],and adverse reactions[OR=0.25,95%CI(0.11,0.57),P=0.001]of clearing heat and cooling blood method or its combination with Acitretin Capsules were better than Acitretin Capsules used alone.The top 10 Chinese medicines were rehmannia,Paeoniae Radix Rubra,paeonol,honeysuckle,comfrey,rhizoma smilacis glabrae,salvia miltiorrhiza,cornu bubali,Spatholobus suberectus,and angelica according to frequency in clinical use.Conclusion:Based on the current evidence,the treatment of psoriasis by using Chinese medicine with the effect of clearing heat and cooling blood alone or in combination with Acitretin Capsules can better improve the efficacy,and its mechanism may be related to decreased inflammation.Due to the limitation of the included literature,this conclusion needs to be further verified.