玉屏风联合枸地氯雷他定治疗慢性荨麻疹有效性和安全性的荟萃分析

Systematic Evaluation of the Efficacy and Safety of Yupingfeng Combined with Desloratadine Citrate Diso-dium in the Chronic Urticaria

目的系统评价玉屏风联合枸地氯雷他定治疗慢性荨麻疹(chronic urticaria,CU)有效性和安全性。方法计算机检索The Cochrane Library、PubMed、Embase、中国知网(CNKI)、万方数据库(WangFang Data)和中国生物医学文献数据库(CBM),纳入评价玉屏风联合枸地氯雷他定治疗CU的随机对照试验(randomized controlled trial,RCT),检索时限从建库至2021年6月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Revman 5.4软件进行Meta分析。结果共纳入19项RCT研究,包括1919例患者,治疗组956例,对照组963例。Meta分析结果显示:有效性方面,玉屏风联合枸地氯雷他定治疗CU在总有效率[OR=4.17,95%CI(2.96,5.86),P<0.01]、痊愈率[OR=2.10,95%CI(1.71,2.58),P<0.01]、复发率[OR=0.18,95%CI(0.13,0.28),P<0.01]、免疫球蛋白E(immunoglobulin E,IgE)[MD=-28.99,(95%CI:-35.56~-22.41),P<0.01]、皮肤病生活质量指数(drmatology life quality index,DLQI)[MD=-5.84,(95%CI:-6.30~-5.37),P<0.01]、风团个数[MD=-5.09,(95%CI:-5.40~-4.78),P<0.01]、风团数目评分[MD=-0.34,(95%CI:-0.37~-0.32),P<0.01]、风团持续时间[MD=-3.45,(95%CI:-3.83~-3.08),P<0.01]、风团发作频率[MD=-9.03(95%CI:-9.63~-8.43),P<0.01]、临床症状积分[MD=-2.10(95%CI:-2.62~-1.57),P<0.01]和白细胞介素-4(Interleukin-4,IL-4)[MD=-20.08,(95%CI:-27.41~-12.75),P<0.01]方面均显著优于对照组,差异有统计学意义;不良反应方面,治疗组[OR=0.85,(95%CI:0.49~1.46),P=0.55>0.05],差异无统计学意义。结论现有证据表明,玉屏风联合枸地氯雷他定治疗CU安全、有效,不宜复发,较单独使用枸地氯雷他定有明显优势。结果证据受纳入研究的数量和质量限制,上述结论有待更多高质量研究予以验证。

OBJECTIVE To systematically evaluate the efficacy and safety of Yupingfeng with desloratadine citrate disodium in the chronic urticaria(CU).METHODS The Cochrane Library,PubMed,Embase,CNKI,Wanfang Data,and CBM were retrieved until Jun 2021.Two researchers independently screened the literature,extracted the data,and evaluated the risk of bias in the included study,the Revman 5.4 software was used for Meta analysis.RESULTS A total of 19 randamized controlled trials(RCT)were included in the analysis,including 1919 patients,956 in the experimental group and 963 in the control group.Meta-analysis results showed that:in terms of effectiveness,the total effective rate of Yupingfeng combined with desloratadine citrate disodium in the chronic urticaria[OR=4.17,95%CI(2.96,5.86),P<0.01],cure rate[OR=2.12,95%CI(1.59,2.82),P<0.01],recurrence rate[OR=0.18,95%CI(0.13,0.28),P<0.01],immunoglobulin E(IgE)[MD=-28.99,(95%CI:-35.56--22.41),P<0.01],drmatology life quality index(DLQI)[MD=-5.84,(95%CI:-6.30--5.37),P<0.01],wind group number[MD=-5.09,(95%CI:-5.40--4.78),P<0.01],score the number of wind clusters[MD=-0.34,(95%CI:-0.37--0.32),P<0.01],duration of wind cluster[MD=-3.45,(95%CI:-3.83--3.08),P<0.01],frequency of wind cluster occurrence[MD=-9.03(95%CI:-9.63--8.43),P<0.01],clinical symptom score[MD=-2.10(95%CI:-2.62--1.57),P<0.01]and interleukin-4(IL-4)[MD=-20.08,(95%CI:-27.41--12.75),P<0.01][MD=-5.58,(95%CI:-6.38--4.78),P<0.01]were significantly better than the control group,and the difference was statistically significant.In terms of adverse reac-tions,there was no statistical significance in the study group[OR=0.85,(95%CI:0.49-1.46),P=0.55>0.05].CONCLUSION The existing evidence shows that Yupingfeng with desloratadine citrate disodium is safe and effective in the treatment of chronic urticaria,and has obvious advantages over desloratadine citrate disodium alone.The evidence was limited by the quantity and quality of the included studies,and the above conclusions need to be verified by more high-quality studies.