中成药治疗强直性脊柱炎的有效性与安全性的网状Meta分析

Network Meta-analysis of efficacy and safety of Chinese patent medicines in treatment of ankylosing spondylitis

运用频率学网状Meta分析评价中成药治疗强直性脊柱炎(AS)的有效性及安全性。计算机检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献数据库(CBM)、PubMed、EMbase、Cochrane Library数据库,自建库至2021年1月收录的中成药治疗AS的随机对照试验(RCTs),用Cochrane偏倚风险评估工具对纳入文献进行质量评价,用RevMan 5.3、Stata/MP 15.1进行分析。最终纳入55项RCTs,12种中成药。网状Meta分析结果显示,在提升治疗AS总有效率方面,排名前3的干预措施为痹祺胶囊+常规西药、益肾蠲痹丸+常规西药、腰痹通胶囊+常规西药;降低血沉(ESR)方面,排名前3的干预措施为益肾蠲痹丸+常规西药、仙灵骨葆胶囊+常规西药、复方玄驹胶囊+常规西药;降低C-反应蛋白(CRP)方面,排名前3的干预措施为痹祺胶囊+常规西药、仙灵骨葆胶囊+常规西药、复方玄驹胶囊+常规西药;安全性方面,不良反应较少的前3种干预措施为白芍总苷胶囊+常规西药、益肾蠲痹丸+常规西药、尪痹片+常规西药。结果提示,中成药联合常规西药治疗可有效改善AS患者关节疼痛症状,降低急时相炎症指标,安全性高,但所纳入的研究方法学质量偏低,故该结论仍需更多高质量研究予以验证。

To evaluate the efficacy and safety of Chinese patent medicines in the treatment of ankylosing spondylitis(AS)by frequency network Meta-analysis.Randomized controlled trials(RCTs)of Chinese patent medicines for AS were retrieved from CNKI,Wanfang,VIP,CBM,PubMed,EMbase and Cochrane Library databases from the time of database establishment to January 2021.The quality of the included RCTs was evaluated according to the Cochrane bias risk standard,and the data was analyzed by RevMan 5.3 and Stata/MP 15.1.A total of 12 kinds of Chinese patent medicines in 55 RCTs were included.According to Meta-analysis,in term of the effectiveness,the top three optimal medication regimens were Biqi Capsules,Yishen Juanbi Pills and Yaobitong Capsules combined with western medicine.The top three interventions to reduce the erythrocyte sedimentation rate(ESR)were Yishen Juanbi Pills,Xianling Gubao Capsules and Fufang Xuanju Capsules combined with western medicine.The top three interventions to reduce the C-reactive protein(CRP)were Biqi Capsules,Xianling Gubao Capsules and Fufang Xuanju Capsules combined with western medicine.In terms of the safety,top three optimal medication regimens were Total Glucosides of Paeony Capsules,Yishen Juanbi Pills,and Wangbi Tablets combined with western medicine.This network Meta-analysis suggests that Chinese patent medicines combined with conventional western medicine can effectively improve the joint pain symptoms of AS patients and reduce the acute inflammatory indicators,with high safety.However,the literature included in this study is generally of low methodological quality,and the conclusion needs to be verified by high-quality research.