中医药治疗宫颈高危型人乳头瘤病毒感染性疾病的系统评价

Chinese medicine for treating cervical high-risk HPV infection: a systematic review

关键词:  中医药  宫颈高危型人乳头瘤病毒  HR-HPV  系统评价  Meta分析

Key words:  traditional Chinese medicine  cervical high-risk human papillomavirus infection  HR-HPV  systematic review  Meta-analysis

摘要:

[目的]系统评价中医药治疗宫颈高危型人乳头瘤病毒感染性疾病的有效性与安全性。[方法]计算机检索中国知网、万方、维普、SinoMed、PubMed及Cochrane数据库，检索期限均从建库至 2018年9月。检索中医药治疗宫颈高危型人乳头瘤病毒（HR-HPV）感染性疾病的随机对照试验（RCT），两名评价者独立进行文献筛选与数据提取，采用Cochrane系统评价手册推荐的偏倚风险评估工具对纳入研究进行质量评价，争议通过讨论或咨询第三方解决。[结果]初检得到3 015条文献题录，经筛选最终纳入14个RCT，共1 394例患者。Meta分析结果：14个研究报告了转阴率，中医药与空白对照研究数据Meta分析显示：中医药可提高HR-HPV转阴率[RR=2.63，95%CI（1.96，3.52），P<0.000 01]；中医药与西药对照研究数据Meta分析显示：中医药在提高HR-HPV转阴率方面疗效优于西药[RR=1.34，95%CI（1.09，1.64），P=0.005]；11个研究报告了总有效率，5个研究报告了宫颈炎症状改善积分，结果均提示中医药对宫颈高危型人乳头瘤病毒感染性疾病有一定的疗效；安全性方面，2个研究报告"无不良反应"，2个研究报告了局部刺痛、肿胀、潮红、糜烂及瘙痒等不良反应。[结论]在预防及治疗宫颈高危型人乳头瘤病毒感染性疾病方面，中医药具有一定的疗效。由于相关高质量的中医药随机对照试验数量较少，故需要更多研究来进一步验证。

Abstract:

[Objective] To evaluate the efficacy and safety of Chinese medicine on the treatment of cervical high-risk human papillomavirus infection (cervical hr-HPV infection).[Methods] CNKI,Wanfang,VIP,Sinomed,PubMed and The Cochrane Library from the inception to September 2018 were searched,and randomized controlled trials (RCTs) of Chinese medicine treating cervical high-risk HPV infection were collected. Two reviewers independently screened literature out and extracted data. The quality of inclusion studies was assessed using the bias risk assessment tool recommended by the Cochrane Handbook of Systematic Review,the dispute resolved through discussion or consulted with the third reviewers.[Results] The 3 015 literature were searched,14 RCTs were screened out according to the inclusion criteria,and 1 394 patients were included in this study. The result of meta-analysis showed that fourteen studies reported negative rates. One subgroup showed that Chinese medicine is significantly effective in increasing HR-HPV negative rate[RR=2.63,95%CI (1.96,3.52),P<0.000 01],while another subgroup showed that Chinese medicine was superior to Western medicine[RR=1.34,95%CI (1.09,1.64),P=0.005]. Eleven studies reported the total effective rate and five studies reported improvements in cervical inflammation scores,those all suggested that Chinese medicine is certainty effective on cervical high-risk human papillomavirus infection diseases. Two studies reported "no adverse reactions". Two studies reported adverse reactions including local tingling,swelling,flushing,erosion and pruritus.[Conclusion] Chinese medicine is effective in the prevention and treatment of cervical high-risk human papillomavirus infectious diseases. Due to the few high quality RCTs in traditional Chinese medicine,more high quality RCTs are needed to verify the above conclusion.