补肾法治疗类风湿关节炎的系统评价

Systematic Review of Kidney Tonifying Therapy in Treatment of Rheumatoid Arthritis

目的:系统评价中医补肾法治疗类风湿关节炎(rheumatoid arthritis,RA)的有效性与安全性。方法:计算机检索中国知网、中国生物医学文献、万方、维普、PubMed等数据库自建库至2021年1月收录的运用补肾法治疗RA的随机对照试验,制定相应的纳排标准筛选文献并提取数据,Meta分析使用RevMan5.3软件。结果:共纳入23个研究总计2338名患者,Meta分析结果显示与对照组比较,补肾治疗组可以显著提高有效率[危险度比(relative risk,RR)=1.22,95%置信区间(confidence interval,CI)(1.18,1.27),P<0.00001],降低RA患者血沉[均数差(mean difference,MD)=-7.31,95%CI(-9.03,-5.58),P<0.00001]、C-反应蛋白[MD=-5.92,95%CI(-7.47,-4.37),P<0.00001],提高25羟基维生素D水平[标准化均数差(standard mean difference,SMD)=0.74,95%CI(0.17,1.31),P=0.01],降低不良反应发生率[RR=0.43,95%CI(0.33,0.54),P<0.00001],差异有统计学意义,2组在血清破骨细胞分化因子、核因子κB受体活化因子配体方面比较无明显差异。结论:目前现有证据可以证明,较单纯西药相比补肾方药联合西药治疗RA可以提高有效率,减轻炎症程度,延迟骨破坏进展并降低不良反应发生率。

Objective:To systematically evaluate the effectiveness and safety of tonifying kidney in treating rheumatoid arthritis.Methods:Randomized controlled trials of tonifying kidney for RA collected from CNKI,Chinese biomedical literature,Wanfang,Weipu,PubMed and other databases from January,2021 were searched by computer,and the corresponding standard of exclusion was established to screen the literature and extract the data.Meta-analysis was carried out by RevMan5.3 software.Results:A total of 2338 patients were included in 23 studies.Meta-analysis showed that compared with the control group,the kidney-tonifying treatment group can significantly improve the effective rate[relativerisk(RR)=1.22,95%confidenceinterval(CI)(1.18,1.27),P<0.00001],and reduce the erythrocyte sedimentation rate of RA patients[meandifference]Md=-7.31,95%CI(-9.03,-5.58),P<0.00001,c-reactive protein[MD=-5.92,95%CI(-7.47,-4.37),P<0.00001]1.31,P=0.01,reducing the incidence of adverse reactions[RR=0.43,95%CI(0.33,0.54),P<0.00001],the difference was statistically significant.There was no significant difference in serum osteoclast differentiation factor and nuclear factorκB receptor activator ligand between the two groups.Conclusion:At present,the existing evidence can prove that compared with pure western medicine,kidney-tonifying prescription combined with western medicine can improve the effective rate,reduce the degree of inflammation,delay the progress of bone destruction and reduce the incidence of adverse reactions.