中西医结合治疗重症肌无力临床随机对照试验的Meta分析

A Meta-analysis of Randomized Controlled Trials with Integrated Chinese and Western Medicine in Treating Myasthenia Gravis

目的:系统评价中西医结合疗法治疗重症肌无力的临床疗效。方法:全面检索中国期刊全文数据库(CNKI)、中国生物医学文献服务系统、万方医药期刊数据库、维普中文科技期刊全文数据库(VIP)、Pubmed、Cochrane图书馆等数据库。检索中西医结合疗法治疗重症肌无力的随机对照临床试验文献,时间区间设定为2000年1月1日—2017年12月31日。根据Jadad评分标准对纳入文献进行质量评价。采用Review Manager 5.3进行数据分析。结果:最终纳入22个随机对照临床试验,共1972例研究对象。纳入的22篇文献中,有18项对有效率进行了观察,17项研究可提取有效数据,RR值为1.16,95%CI为[1.07,1.25],P<0.001,统计学呈显著性差异;有4项进行了复发率的观察,其中3项可提取有效数据,RR值为0.11,95%CI为[0.05,0.23],P<0.001,有统计学差异;有7项观察了抗乙酰胆碱抗体(AchR-Ab),试验组与对照组比较,MD值为-0.29,95%CI为[-0.42,-0.16],P<0.05,差异具有统计学意义;有8项进行了临床绝对评分,MD值为-0.58,95%CI为[-1.98, 0.81],P=0.41>0.05,差异无统计学意义;有5项进行了临床相对评分,MD值为0.28,95%CI为[0.03, 0.53],P=0.03<0.05,差异有统计学意义。结论:中西医结合治疗重症肌无力相较于单纯西药治疗,在提高有效率、降低复发率以及改善病情方面具有明显的优势。

Objective:To systematically evaluate the clinical effect of integrated Chinese and western medicine in the treatment of myasthenia gravis(MG).Methods:Randomized controlled trials with integrated Chinese and western medicine in treating myasthenia graviswere comprehensively searched in China National knowledge infrastructure(CNKI),Chinese Biomedical Literature Database(CBM),Wan Fang Database,Chinese VIP database,Pubmed and the Cochrane Library.The time frame range was from January 1,2000 to December 31,2017.The methodological quality of the research was evaluated according to the Jadad score standard.Review Manager 5.3 was selected to analysis the data.Results:Twenty-two randomized controlled clinical trials were eventually included with 1972 cases.Experimental group compared with control group:Effective rate was observed in 18 participants of the research in the studies,the data could be extracted from 17 studies,RR and 95%CI were 1.16[1.07,1.25],P<0.001,which had significant difference in statistics.Recurrence rates were observed in 4 studiesand the data could be extracted effectively from 3 studies,RR and 95%CI were 0.11[0.05,0.23],P<0.001,which had significant difference in statistics.AchR-Ab was reported in 7 studies,MD and 95%CI were-0.29[-0.42,-0.16],P<0.05,which had difference in statistics.The clinical absolute score was observed in 8 studies,MD and 95%CI were-0.58[-1.98,0.81],P=0.41>0.05,which had no significant difference in statistics.The clinical relative score was observed in 5 studies,MD and 95%CI were 0.28[0.03,0.53],P=0.03<0.05,which had difference in statistics.Conclusion:Integrated Chinese and western medicine treatment of myasthenia gravis compared to western medicine treatment has obvious advantages in improving the efficiency,reducing the recurrence rate and improving patients’condition.