目的:系统评价中成药复方制剂联合常规治疗用于寻常型银屑病疗效与安全性的差异,为临床用药提供循证参考。方法:计算机检索中国知网、万方数据、维普网、中国生物医学文献数据库、Pub Med、Cochrane图书馆、Web of Science等数据库,收...目的:系统评价中成药复方制剂联合常规治疗用于寻常型银屑病疗效与安全性的差异,为临床用药提供循证参考。方法:计算机检索中国知网、万方数据、维普网、中国生物医学文献数据库、Pub Med、Cochrane图书馆、Web of Science等数据库,收集不同中成药复方制剂联合常规治疗对比常规治疗用于寻常型银屑病的随机对照试验(RCT),检索时限均为各数据库建库起至2020年2月。筛选文献,提取资料后采用Cochrane系统评价员手册5.1推荐的偏倚风险评估工具对纳入文献质量进行评价,采用Stata 15.0软件、Addis 1.16.6软件以及马尔科夫链-蒙特卡洛方法进行贝叶斯网状Meta分析。结果:共纳入41项RCT,共计4122例患者;涉及复方青黛胶囊、消银颗粒、克银丸、郁金银屑片、常规治疗等5种干预措施。网状Meta分析结果显示,在提高总有效率方面,与常规治疗比较,4种不同中成药复方制剂联合常规治疗均可显著提高患者的总有效率(P<0.05);网状Meta排序结果为克银丸联合常规治疗>复方青黛胶囊联合常规治疗>消银颗粒联合常规治疗>郁金银屑片联合常规治疗>常规治疗。在降低治疗后银屑病面积和严重程度指数(PASI)评分方面,与常规治疗比较,克银丸、消银颗粒联合常规治疗均显著可降低患者的PASI评分(P<0.05),而复方青黛胶囊、郁金银屑片联合常规治疗与常规治疗比较,差异均无统计学意义(P>0.05);网状Meta排序结果为消银颗粒联合常规治疗>克银丸联合常规治疗>复方青黛胶囊联合常规治疗>郁金银屑片联合常规治疗>常规治疗。在降低血清炎性因子水平方面,与常规治疗比较,复方青黛胶囊、消银颗粒联合常规治疗均可显著降低患者的白细胞介素17水平(P<0.05),而克银丸、郁金银屑片联合常规治疗与常规治疗比较,差异均无统计学意义(P>0.05);网状Meta排序结果为消银颗粒联合常规治疗>复方青黛胶囊联合常规治疗>郁金银屑片联合常规治疗>克银丸联合常规治疗>常规治疗。在安全性方面,4种中成药复方制剂联合常规治疗与常规治疗的不良反应发生率比较,差异均无统计学意义(P>0.05);网状Meta排序结果为复方青黛胶囊联合常规治疗>消银颗粒联合常规治疗>克银丸联合常规治疗>常规治疗>郁金银屑片联合常规治疗。结论:与常规治疗比较,加用4种中成药复方制剂均可提高寻常型银屑病血热证患者的疗效,以克银丸最佳;在降低患者皮损程度及血清炎性因子方面,以消银颗粒最佳;加用4种中成药复方制剂的安全性均较好,以复方青黛胶囊最佳。展开更多
With its long-term empirical clinical practice and increasing number of health benefits reported,Chinese Materia Medica(CMM)is gaining increasing global acceptance.Importantly,the identification of chemical constituen...With its long-term empirical clinical practice and increasing number of health benefits reported,Chinese Materia Medica(CMM)is gaining increasing global acceptance.Importantly,the identification of chemical constituents in vitro and exposed forms in vivo is a prerequisite for understanding how CMM formulae prevent and treat diseases.This review systematically summarizes the exciting and magical journey of CMM components from compound formulae to where they fight,the possible structural transformation of CMM components in vitro and in vivo,and their pharmacological contribution.When a decoction is prepared,significant chemical reactions are observed,including degradation and production of polymers and self-assembling supramolecules,leading to the construction of a component library with diverse decoction structures.After ingestion,compounds pass through the intestinal and blood-brain barriers and undergo a more wonderful journey involving the gut microbiota,microbial enzymes,and endogenous drug-metabolizing enzymes(mainly liver enzymes).At this stage,they are modified and assembled into novel and complex compounds,such as newly generated metabolites,conjugates,and self-assembling superamolecules.This review might provide a strategic orientation to explore the active compounds of CMM formulae in vivo.展开更多
基金supported by the National Natural Science Foundation of China(81873192 and 81202877)Postgraduate Research and Innovation Project of Tianjin(2021YJSB288 and YJSKC-20211004)the Science and Technology Program of Tianjin(Grant No.20ZYJDJC00070)
文摘With its long-term empirical clinical practice and increasing number of health benefits reported,Chinese Materia Medica(CMM)is gaining increasing global acceptance.Importantly,the identification of chemical constituents in vitro and exposed forms in vivo is a prerequisite for understanding how CMM formulae prevent and treat diseases.This review systematically summarizes the exciting and magical journey of CMM components from compound formulae to where they fight,the possible structural transformation of CMM components in vitro and in vivo,and their pharmacological contribution.When a decoction is prepared,significant chemical reactions are observed,including degradation and production of polymers and self-assembling supramolecules,leading to the construction of a component library with diverse decoction structures.After ingestion,compounds pass through the intestinal and blood-brain barriers and undergo a more wonderful journey involving the gut microbiota,microbial enzymes,and endogenous drug-metabolizing enzymes(mainly liver enzymes).At this stage,they are modified and assembled into novel and complex compounds,such as newly generated metabolites,conjugates,and self-assembling superamolecules.This review might provide a strategic orientation to explore the active compounds of CMM formulae in vivo.
