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| “从毒论治”治疗痛风的有效性与安全性系统评价 |
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李虽然1,2,3, 刘维1,2,3, 王怡文1,2,3, 张嘉珉1,2,3, 唐卓1,2,3, 王文1,2,3
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1.天津中医药大学第一附属医院风湿免疫科, 天津 300381;2.国家中医针灸临床医学研究中心, 天津 300381;3.天津中医药大学, 天津 301617
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| 摘要: |
| [目的] 系统评价运用“清利活血解毒”法从毒邪论治痛风的中医药方案及其临床效果与安全性。[方法] 系统检索中英文数据库（中国知网、万方数据知识服务平台、维普数据库、PubMed），发表时间从建库至2024年12月1日，纳入符合标准的随机对照试验。使用Cochrane偏倚风险评估工具2.0（RoB 2.0）评价文献质量，运用RevMan 5.4进行Meta分析，GRADE系统评价证据质量。[结果] 共纳入10项研究，总样本量为960例。与单纯西药治疗相比，“从毒论治”中药干预后在多项指标显示出更优效果，包括提高临床有效率[相对危险度（RR）=1.20， 95%置信区间（CI）（1.13，1.27），P＜0.000 01]；降低中医症状积分[标准化均数差（SMD）=-1.55，95%CI（-1.87，-1.22），P<0.000 01]；降低关节疼痛评分[SMD=-1.05，95%CI（-1.21，-0.89），P<0.000 01]；降低关节活动受限评分[SMD= -0.95，95%CI（-1.17，-0.72），P<0.000 01]；降低血尿酸[均数差（MD）=-48.73，95%CI（-55.63，-41.83），P<0.000 01]；降低血沉[MD=-4.75，95%CI（-5.28，-4.22），P<0.000 01]；降低C反应蛋白[MD=-6.24，95%CI（-6.73，-5.75），P<0.000 01]；降低肿瘤坏死因子-α[MD=-7.22，95%CI（-8.48，-5.96），P<0.000 01]；降低白细胞介素-6[MD=-4.45，95%CI（-5.31， -3.59）， P<0.000 01]。同时不良反应发生率显著降低[RR=0.59，95%CI（0.35，0.99），P=0.05]。[结论] “从毒论治”中药治疗联合西药治疗痛风可以显著提高疗效，并具有更好的安全性。 |
| 关键词: 中医药 从毒论治 清利活血解毒 痛风 Meta分析 |
| DOI：10.11656/j.issn.1673-9043.2025.10.08 |
| 分类号:R589.7 |
| 基金项目:天津市南开区中医药传承创新发展示范试点项目（2024020411）；国家中医药管理局-重大疑难疾病中西医临床协作项目；全国名老中医药专家传承工作室项目（975022）；中医药传承与创新“百千万”人才工程（岐黄工程）项目（中医药人民教育函〔2018〕12号）；国家中医药管理局中医药重点学科能力提升项目（2018ZDXK001）；天津市科技计划项目（22KPXMRC00180）。 |
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| Systematic review on efficacy and safety of treating gout based on the theory of “managing toxin pathogenesis” |
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LI Suiran1,2,3, LIU Wei1,2,3, WANG Yiwen1,2,3, ZHANG Jiamin1,2,3, TANG Zhuo1,2,3, WANG Wen1,2,3
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1.Department of Rheumatology and Immunology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China;2.National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China;3.Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
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| Abstract: |
| [Objective] To systematically evaluate the clinical efficacy and safety of traditional Chinese medicine(TCM) interventions for gout based on the "clearing dampness,promoting blood circulation,and detoxifying" method from the perspective of toxin pathogenesis. [Methods] Randomized controlled trials(RCTs) meeting the inclusion criteria were systematically retrieved from Chinese and English databases(CNKI,Wanfang,VIP,and PubMed) from their inception to December 1,2024. The Cochrane Risk of Bias Tool 2.0(RoB 2.0) was used to assess literature quality,RevMan 5.4 was employed for Meta-analysis,and the GRADE system was applied to evaluate the quality of evidence. [Results] Ten studies involving 960 patients were included. Compared with Western medicine treatment alone,TCM interventions based on the "managing toxin pathogenesis" theory demonstrated superior outcomes in multiple indicators:improved clinical response rate[RR=1.20,95%CI(1.13,1.27),P<0.000 01];reduced TCM syndrome score[SMD=-1.55,95%CI(-1.87,-1.22),P<0.000 01];decreased joint pain score[SMD=-1.05, 95%CI(-1.21,-0.89),P<0.000 01];reduced joint mobility limitation score[SMD=-0.95,95%CI(-1.17,-0.72),P<0.000 01];decreased serum uric acid[MD=-48.73,95%CI(-55.63,-41.83),P<0.000 01];reduced erythrocyte sedimentation rate[MD=-4.75,95%CI(-5.28,-4.22),P<0.000 01];lowered C-reactive protein[MD=-6.24,95%CI(-6.73,-5.75),P<0.000 01];decreased tumor necrosis factor-α[MD=-7.22,95%CI(-8.48,-5.96),P<0.000 01];and reduced interleukin-6[MD=-4.45,95%CI(-5.31,-3.59),P<0.000 01]. Furthermore,the incidence of adverse reactions was significantly lower[RR=0.59,95%CI(0.35,0.99),P=0.05]. [Conclusion] Integrated treatment with TCM based on the "managing toxin pathogenesis" theory combined with Western medicine can significantly improve clinical efficacy and exhibit better safety in treating gout. |
| Key words: traditional Chinese medicine managing toxin pathogenesis clearing dampness,promoting blood circulation and detoxifying gout Meta-analysis |
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