蠲痹汤类治疗类风湿关节炎有效性及安全性的Meta分析

Meta-analysis of Efficacy and Safety of Juanbi Decoction(蠲痹汤)in Treatment of Rheumatoid Arthritis

目的系统评价蠲痹汤类中药方剂联合西医常规疗法治疗类风湿关节炎(RA)有效性以及安全性。方法用计算机检索知网、万方、维普、Pubmed等数据库检索文献,收集蠲痹汤类联合西医常规疗法治疗类风湿关节炎随机对照试验(RCT)进行筛选,对纳入的文献进行Rev Man 5.3软件进行分析和质量评价。结果共纳入符合纳排标准的RCT研究文献18篇,共1636例,Meta分析结果显示:蠲痹汤联合西药辅助治疗类风湿关节炎有效率优于单纯使用西药常规治疗(RR=1.27,95%CI[1.21,1.33],P<0.000 01)、关节疼痛(MD=-1.34,95%CI[-1.68,-1.00],P<0.000 01)、关节压痛(MD=-1.57,95%CI[-2.14,-1.00],P<0.000 01)、肿胀(MD=-1.61,95%CI[-1.82,-1.40],P<0.000 01)、晨僵(SMD=-2.09,95%CI[-3.22,-0.95],P=0.0003)、CRP(MD=-4.58,95%CI[-6.21,-2.94],P<0.000 01)、ESR(SMD=-2.1,95%CI[-3.84,-1.57],P<0.000 01)、RF(SMD=-1.70,95%CI[-1.90,-1.51],P<0.000 01)、不良反应(RR=-0.32,95%CI[0.16,0.66],P=0.002)。结论蠲痹汤治疗类风湿关节炎可以提高临床有效率,减少不良反应的发生。

Objective To systematically evaluate the efficacy and safety of Juanbi Decoction(蠲痹汤) combined conventional western medicine therapy in the treatment of rheumatoid arthritis(RA). Method The literature was retrieved by computer from HowNet, Wanfang, VIP, PubMed and other databases to collect randomized controlled trials(RCTs) on Juanbi Decoction combined with conventional western medicine therapy for RA. RevMan 5.3 software was used for the literature analysis and quality evaluation. Results A total of 18 RCTs were enrolled, a total of 1636 cases. Meta-analysis showed Juanbi Decoction combined western medicine was superior to the conventional western medicine therapy alone in the effective rate[RR=1.27,95% CI(1.21,1.33], P<0.000 01],joint pain[MD=1.34, 95% CI(1.68,1.00), P<0.000 01], joint tenderness[MD=1.57, 95% CI(2.14,1.00), P<0.000 01], swelling[MD =1.61, 95% CI(1.82,1.40), P<0.000 01], morning stiffness[SMD=2.09,95% CI(3.22,0.95), P=0.0003],CRP[MD=4.58, 95% CI(6.21, 2.94),P<0.000 01], ESR[SMD=2.1,95% CI(3.84,1.57), P<0.000 01], RF[SMD = 1.70, 95% CI(1.90,1.51),P<0.000 01] and adverse reactions[RR=0.32,95% CI(0.16, 0.66],P=0.002]. Conclusion Juanbi Decoction in the treatment of rheumatoid arthritis can improve the clinical effective rate and reduce the occurrence of adverse reactions.