3种具有免疫调节作用的中成药治疗寻常型银屑病的系统评价与网状Meta分析

Three kinds of Chinese patent medicine for immunodulation in treating psoriasis vulgaris：A systematic review and network Meta-analysis

关键词:  寻常型银屑病  复方甘草酸苷  白芍总苷  雷公藤多苷  系统评价  网状Meta分析

Key words:  psoriasis vulgaris  compound glycyrrhizin  total glucosides of paeony  tripterygium glycosides  systematic review  network Meta-analysis

摘要:

[目的] 复方甘草酸苷（CG）、白芍总苷（TGP）和雷公藤多苷（TG）均具有免疫调节作用，其治疗寻常型银屑病（PV）的疗效可能存在差异，这使得临床医生在具体选择时缺乏明确的指导。研究旨在评估CG、TGP、TG联合常规治疗（RT）对PV的疗效和安全性，以为临床应用提供循证参考。[方法] 研究纳入了自建库至2024年8月共8个数据库的文献，纳入以PV为研究对象的随机对照试验（RCT），对照组接受RT，治疗组在RT的基础上联合CG、TGP、TG。用贝叶斯网状Meta分析分析评价银屑病皮损面积和严重性指数（PASI）90应答率、PASI评分、白细胞介素（IL）-17水平等指标，疗效排名采用累积排名曲线下曲面（SUCRA）进行评估。[结果] 共纳入61项研究，涉及5 660例患者，分析了CG、TGP、TG联合RT的疗效。与RT相比，CG、TGP、TG均显著提高了PASI90应答率、改善了PASI评分，并降低了IL-17水平。SUCRA排名结果显示，CG在PASI90应答率和IL-17改善方面表现最佳，而TG在PASI评分改善方面效果最显著。对照组不良事件发生率高于治疗组，两组比较差异具有统计学意义，安全性良好。[结论] CG、TGP、TG在联合RT中均对PV的治疗有显著益处。CG可能在提高PASI90应答率的和降低IL-17水平方面表现最佳，TG在降低PASI方面效果更为突出。

Abstract:

[Objective] Compound glycyrrhizin（CG），total glucosides of paeony（TGP），and tripterygium glycosides（TG） all possess immunomodulatory properties. However，their therapeutic efficacy in the treatment of psoriasis vulgaris（PV） may differ，creating uncertainty in clinical decision-making. This study aims to evaluate the efficacy and safety of CG，TGP and TG，each in combination with regular treatment（RT），in the management of PV，in order to provide evidence-based guidance for clinical practice. [Methods] This study included literature from eight databases up to August 2024，selecting randomized controlled trials（RCTs） that focused on PV. The control group received RT，while the treatment group received RT combined with CG，TGP or TG. A Bayesian network Meta-analysis（NMA） was performed to assess the psoriasis area and severity index（PASI） 90 response rate，PASI score，interleukin（IL）-17 levels，and other outcomes. The efficacy ranking was evaluated using the surface under the cumulative ranking（SUCRA）. [Results] A total of 61 studies involving 5 660 patients were included to assess the efficacy of CG，TGP and TG in combination with RT. Compared with RT alone，all three interventions（CG，TGP，and TG） significantly improved the PASI90 response rate，reduced PASI scores，and decreased IL-17 levels. According to SUCRA ranking results，CG showed the best performance in terms of PASI90 response rate and IL-17 reduction，while TG demonstrated the most significant improvement in PASI scores. The incidence of adverse events in the control group was higher than in the treatment groups，with a statistically significant difference，indicating good safety profiles for the treatment regimens. [Conclusion] CG，TGP and TG each demonstrated significant therapeutic benefits for PV when combined with RT. CG may be the most effective in enhancing the PASI90 response rate and reducing IL-17 levels，while TG appeared to be more prominent in improving PASI scores.