硫嘌呤联合5-氨基水杨酸类药物与单用硫嘌呤类药物用于炎症性肠病疗效和安全性比较的Meta分析

Efficacy and Safety of the Combination of Thiopurine with 5-Aminosalicylates versus Thiopurines Alone for the Inflammatory Bowel Disease:A Meta Analysis

目的系统评价硫嘌呤(AZA/6-MP)联合5-氨基水杨酸类药物(5-ASA)对比单用AZA/6-MP治疗炎症性肠病的疗效和安全性。方法按照纳入与排除标准用计算机检索The Cochane Library、PubMed、迈特思创、CBM、万方数据库、重庆维普(VIP)和中国知网数据库建库至2019年10月相关研究。筛选文献、提取资料和评价偏移风险由2名研究员独立完成后,采用RevMan 5.3和Stata12.0版软件进行Meta分析。结果共纳入12个研究,共计3751例患者。Meta分析结果显示:与单用AZA/6-MP组比较,AZA/6-MP和5-ASA联合使用组6-TGN水平较高[MD=24.45,95%CI(48.63,-40.28)%,P<0.05]、6-MMP水平差异无统计学意义(P>0.05);在不良反应方面,与单用AZA/6-MP比较,AZA/6-MP和5-ASA联合使用组总不良反应发生率较低[OR=1.78,95%CI(1.03,3.08)%,I 2=63%,P<0.05]。结论当前研究显示,AZA/6-MP和5-ASA联合使用组疗效优于AZA/6-MP单用组,且联合使用未增大不良反应发生率。

Objective To evaluate the efficacy and safety of the combination of thiopurines with 5-aminosalicylates versus thiopurines for inflammatory bowel disease.Methods The Cochane Library,PubMed,FMRS,CBM,WangFang Data,VIP and CNKI were searched online from the establishment dates of the databases to October 2019 to collect relevent studies.RevMan 5.3 and Stata 12.0 software were used to perform meta-analysis after selected literatures.Two independent reviewers extracted data and evaluated the risk of deviation of the included studies.Results A total of 12 studies were included with a total of 3751 patients.Meta-analysis results showed that AZA/6-MP+5-ASA group had a higher level of 6-TGN[MD=24.45,95%CI(48.63,-40.28)%,P<0.05],and there were no significant difference in 6-MMP level(P>0.05).For safety,AZA/6-MP+5-ASA group had a lower rate of overall adverse reactions[OR=1.78,95%CI(1.03,3.08)%,I 2=63%,P<0.05].Conclusion The current evidence shows that the combination of thiopurines with 5-aminosalicylates have a better effect and lower adverse reaction incidences than thiopurines alone.