中医药治疗重症肌无力系统评价/Meta分析的再评价

Traditional Chinese Medicine for Myasthenia Gravis: A Reevaluation on Systematic Review/Meta-analysis

目的对中医药治疗重症肌无力的系统评价/Meta分析的结论可靠程度进行再评价研究。方法计算机检索中国知网、维普网、万方数据、中国生物医学数据库、PubMed、EMBase、Cochrane Library数据库,查找中医药治疗重症肌无力的系统评价/Meta分析的文献,检索时限均为从建库至2018年9月30日,分别采用AMSTAR量表、GRADE工具对纳入的研究进行方法学质量评价、结局指标证据质量分级,并对主要结局指标进行描述分析。结果共纳入7篇系统评价/Meta分析,有28个结局指标。其中6篇采用中药联合西药与单纯西药治疗进行比较,1篇采用单纯中药与单纯西药治疗进行比较。AMSTAR量表评分显示,3篇分值在11~16分,属于中等质量;4篇分值在17~22分,属于高质量。GRADE分级显示,23个结局指标证据质量为低或极低,仅有5个为中级质量,主要体现在复发率、中医证候积分、不良反应方面。描述分析结果显示,中医药治疗重症肌无力,可提高总有效率,降低临床绝对评分、临床相对评分,减少复发率、不良反应发生率(P <0. 05或P <0. 01)。结论中医药治疗重症肌无力系统评价/Meta分析的方法学质量为中高等级,但结论的证据强度较低。现有证据表明,中医药联合西药在治疗重症肌无力上可能有协同增效的作用。

Objective To conduct a reevaluation study on systematic review/Meta-analysis of traditional Chinese medicine(TCM)treatment of myasthenia gravis(MG),in order to evaluate the bias and the reliability of the conclusion.Methods We comprehensively searched China National Knowledge Infrastructure(CNKI),VIP database,WanFang database,Chinese Biology Medicine(CBM),PubMed,Embase,The Cochrane Library for literature on systematic review/Meta-analysis of TCM treatment of MG from the establishment time of databases to September 30 th,2018.The literature were evaluated in terms of methodological quality evaluation,outcome index evidence quality grading.Descriptive analysis was conducted to primary outcome index.Results A total of 7 SRs/Meta-analysis were included with 28 outcomes index.6 papers compared the efficacy of TCM combined with western medicine between western medicine alone in treating MG.One systematic review compared the efficacy of TCM alone and western medicine alone.The AMSTAR scale score showed that there were 3 papers with a total score of 11-16,which was of medium quality.4 papers with a total score was between 17 and 22 points,which was of high quality.GRADE grading results showed that evidences of 23 outcome index were of low or extremely low quality,and only 5 outcomes were of intermediate quality,mainly reflected in the recurrence rate,TCM syndrome scores,adverse reactions.Descriptive analysis showed that TCM treatment of MG can improve the total effective rate,reduce the clinical absolute score,clinical relative score,reduce the recurrence rate,the incidence of adverse reactions(P<0.05 or P<0.01).Conclusion The systematic review/Meta-analysis of methodological quality of TCM treatment of MG is medium to high,but the evidence strength of the conclusion is low.The available evidence indicates that TCM combined with western medicine may have synergistic effects in the treatment of MG.