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雷公藤提取物治疗类风湿关节炎的系统评价

Keywords: 雷公藤,类风湿关节炎;系统评价

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Abstract:

目的:评价雷公藤提取物治疗RA的有效性和安全性。方法:收集了全世界关于雷公藤提取物治疗类风湿关节炎的随机对照试验,参照CochraneReviewer'sHandbook4.2.5中的简单方法和《隐蔽分组(分配隐藏)和盲法的概念、实施与报告》对各试验进行方法学质量评价;采用Cochrane协作网提供的Revman4.2统计软件对各试验进行统计分析;以美国风湿病协会推荐的类风湿关节炎病情疗效标准(ACR20/50/70),X线进展评价以及无效率为疗效指标;亚组分析方面,按对照措施的不同分为“与安慰剂对照亚组”和“与缓解病情药对照亚组”。结果:共有7个临床试验符合纳入标准,样本含量均较小,其中6个存在方法学质量欠缺,存在多种偏倚的可能性。疗效评价方面,雷公藤提取物对缓解类风湿关节炎病情有疗效(P<0.05),在减少肿胀关节数、降低CRP方面的疗效与缓解病情药没有差异,在降低ESR方面比缓解病情药疗效要好(P<0.01)。但在延缓RA骨质破坏方面并无明显疗效。雷公藤提取物不良反应发生率较缓解病情药为高。结论:本系统评价提示雷公藤提取物是缓解类风湿关节炎病情的有效药物,但由于纳入的7个RCTs多为低质量研究,使得结论的可靠性下降,尚需大样本、多中心具有完善试验设计,规范的药物用法以及采用公认可靠的疗效评价标准的RCTs来进一步探索。

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