复方甘草酸苷制剂联合雷公藤多苷治疗银屑病的meta分析

A meta-analysis of efficacy and safety of compound glycyrrhizin combined with tripterygium wilfordii polyglycosides in treating psoriasis

目的系统评价复方甘草酸苷联合雷公藤多苷治疗银屑病的临床疗效和安全性。方法检索中国知识资源总库(CNKI)、中国学术期刊数据库(万方数据)、中文科技期刊数据库(重庆维普)、中国生物医学文献服务系统(SinoMed)、PubMed数据库、Cochrane Library及Embase建库至2020年9月28日,有关复方甘草酸苷联合雷公藤多苷治疗银屑病的RCT文献。按照Cochrane 5.0.1系统评价手册偏倚风险评估方法评估文献发表偏倚和质量,采用RevMan 5.3软件进行meta分析。结果共纳入文献10篇,受试者961例,其中试验组为复方甘草酸苷联合雷公藤多苷用药组(486例),对照组为雷公藤多苷组(475例)。Meta分析结果显示,试验组治疗银屑病在总有效率[OR=3.16,95%CI(2.00~4.99),P<0.001]、治愈率[OR=2.56,95%CI(1.94~3.61),P<0.001]、复发率[OR=0.15,95%CI(0.04~0.60),P=0.007]、总不良反应发生率[OR=0.53,95%CI(0.34~0.82),P=0.004]、肝功能异常发生率[OR=0.17,95%CI(0.06~0.47),P=0.001]等方面均优于对照组;在消化道不良反应发生率(P>0.05)、下肢或颜面水肿(P>0.05),与对照组比较,差异均无统计学意义。结论复方甘草酸苷联合雷公藤多苷治疗银屑病较单用雷公藤多苷疗效更好,且可降低复发率和不良反应发生率。但仍需大量大样本、高质量研究支持结论。

Objective To evaluate the clinical efficacy and safety of compound glycyrrhizin combined with tripterygium wilfordii polyglycosides for psoriasis.Methods Literature search was conducted in CNKI,Wanfang,VIP databases,Sinomed,PubMed,the Cochrane Library and Embase with the deadline of September 28th,2020.The randomly controlled trials of compound glycyrrhizin combined with tripterygium wilfordii polyglycosides in treating psoriasis was included.The publication bias and methodology quality of RCTs were evaluated according to the Cochrane 5.0.1 bias risk assessment method.The RevMan 5.3 software was used for meta analysis.Results Ten studies with 961 patients were included,with the experimental group(n=486)and the control group(n=475).The results of meta-analysis showed that the total effective rate[OR=3.16,95%CI(2.00-4.99),P<0.001],the cure rate[OR=2.56,95%CI(1.94-3.61),P<0.001],the recurrence rate[OR=0.15,95%CI(0.04-0.60),P=0.007],the total incidence of adverse reactions[OR=0.53,95%CI(0.34-0.82),P=0.004],the incidence of abnormal liver function[OR=0.17,95%CI(0.06-0.47),P=0.001]in the experimental group were better than those in the control group.There was no significant difference on the incidence of adverse reactions of digestive tract(P>0.05)or lower extremity or facial edema(P>0.05)between both groups.Conclusions Compound glycyrrhizin combined with tripterygium wilfordii polyglycosides is effective in the treatment of psoriasis than tripterygium wilfordii polyglycosides alone,and can reduce the recurrence rate and the incidence of adverse reactions.However,a large number of large samples and high-quality studies are still needed.