加味四妙散联合秋水仙碱治疗急性痛风性关节炎有效性与安全性Meta分析

Efficacy and safety of Jiawei Simiao Powder combined with colchicine for acute gouty arthritis: a Meta-analysis

关键词:  加味四妙散  秋水仙碱  急性痛风性关节炎  Meta分析  随机对照试验

Key words:  Jiawei Simiao Powder  colchicine  acute gouty arthritis  Meta-analysis  randomized controlled trial

摘要:

[目的] 系统评价加味四妙散联合秋水仙碱治疗急性痛风性关节炎的有效性与安全性。[方法] 使用计算机检索中文数据库（中国知网、中国生物医学文献服务系统、维普数据库、万方数据库）和英文数据库（PubMed、Web of Science、The Cochrane Library、EMBASE），搜索加味四妙散联合秋水仙碱治疗急性痛风性关节炎的随机对照试验，检索时间段均为建库至2020年9月。由2名研究者独立筛选文献，收集患者的基线资料和相关指标数据并评价纳入的随机对照试验的偏倚风险后，采用RevMan 5.3软件进行Meta分析。[结果] 通过纳入和排除标准筛选后获得13个随机对照试验，包括1 050例患者。Meta分析结果显示试验组在总有效率[RR=1.18，95% CI（1.12，1.25），P<0.000 01]、关节压痛状况[MD=-0.50，95% CI（-0.58，-0.43），P<0.000 01]、关节肿胀状况[MD=-0.49，95% CI（-0.52，-0.46），P<0.000 01]、血尿酸[MD=-79.40，95% CI（-118.77，-40.04），P<0.000 1]、红细胞沉降率[MD=-9.08，95% CI（-14.00，-4.16），P=0.000 3]、不良反应发生率[RR=0.45，95% CI（0.30，0.68），P=0.000 1]方面均优于对照组，其差异均具有统计学意义。[结论] 当前证据表明，相比单纯使用秋水仙碱，加味四妙散联合秋水仙碱治疗急性痛风性关节炎在总有效率、缓解关节症状、改善血沉指标和安全性方面更有优势，但血尿酸指标结果稳定性较差，还不能得出较为可靠的结论。由于纳入的随机对照试验数量有限，且质量较低，需要更多随机、双盲、大样本的临床研究来证实上述结论。

Abstract:

[Objective] To evaluate the efficacy and safety of Jiawei Simiao Powder combined with colchicine in the treatment of acute gouty arthritis.[Methods] China National Knowledge Infrastructure(CNKI), Chinese Biology Medicine(CBM), VIP databases, Wanfang databases, PubMed, Web of Science, The Cochrane Library and EMBASE were searched for randomized controlled trial(RCT) about Jiawei Simiao Powder combined with colchicine for acute gouty arthritis from inception to September, 2020. Two researchers respectively searched the literature, collated relevant information and data, and evaluated the risk of bias in the included randomized controlled trials. Then, the Meta-analysis was completed by Revman 5.3 software.[Results] The 13 RCT involving 1 050 patients were selected by inclusion and exclusion criteria. The results of Meta-analysis showed that:in the experimental groups, total effective rate[RR=1.18, 95%CI(1.12, 1.25), P<0.000 01], joint tenderness[MD=-0.50, 95%CI(-0.58, -0.43), P<0.000 01], joint swelling[MD=-0.49, 95%CI(-0.52, -0.46), P<0.000 01], UA[MD=-79.40, 95%CI(-118.77, -40.04), P<0.000 1], ESR[MD=-9.08, 95%CI (-14.00, -4.16), P=0.000 3] and adverse reaction rate[RR=0.45, 95%CI(0.30, 0.68), P=0.000 1] were better than those of the control group, and the differences were statistically significant.[Conclusion] Current evidence shows that, compared with colchicine alone, the combination of Jiawei Simiao Powder and colchicine in the treatment of acute gouty arthritis has more advantages in terms of the total effective rate, the relief of joint symptoms, the improvement of erythrocyte precipitation index and safety, but the efficacy of blood uric acid cannot be drawn a more reliable conclusion. However, due to the limited number and low quality of the included randomized controlled trials, more randomized, double-blind, large-sample clinical studies are needed to confirm the conclusion.