摘要
目的:评价中医药联合西医治疗类风湿关节炎伴间质性肺疾病(RA-ILD)的临床疗效和安全性。方法:检索万方数据库、维普数据库、中国知网、中国生物医学文献数据库、PubMed、Web of Science、Embase和the Cochrane Library中中医药联合西医治疗RA-ILD的随机对照试验(研究组为中医药联合西医治疗,对照组为西医治疗),检索时间截至2021年10月15日。用RevMan 5.4软件搜集文献并分析,采用Cochrane协作网的偏倚风险评估量表评价文献质量。结果:共纳入17项研究,包括1254例患者。Meta分析结果显示,与单纯使用西医治疗比较,中医药联合西医治疗能有效提高RA-ILD患者的临床总有效率(RR=1.35,95%CI=1.24~1.47,P<0.00001),改善患者的第1秒用力呼气容积占预计值百分比(FEV_(1)%)(MD=8.75,95%CI=3.98~13.51,P=0.0003)、肺总量占预计值百分比(TLC%)(MD=8.40,95%CI=5.76~11.04,P<0.00001)、第1秒用力呼气容积占用力肺活量百分比(FEV_(1)/FVC)(MD=8.84,95%CI=3.88~13.80,P=0.0005)、红细胞沉降率(ESR)(MD=-5.85,95%CI=-9.22~-2.49,P=0.0007)和类风湿因子(RF)(MD=-8.14,95%CI=-14.90~-1.38,P=0.02)水平,差异均有统计学意义,但对用力肺活量占预计值百分比(FVC%)无明显改善作用(P>0.05);对于一氧化碳弥散量占预计值百分比(DLCO%)、C反应蛋白(CRP)水平,由于各研究间异质性较高,仅进行描述性分析,研究结果表明,中医药联合西药也能改善DLCO%、CRP水平。两组患者不良反应发生情况的差异无统计学意义(P>0.05)。结论:中医药联合西医治疗RA-ILD,可有效提高临床总有效率,同时能改善患者的FEV_(1)%、TLC%、FEV_(1)/FVC、ESR和RF水平,无严重不良反应。但纳入文献质量较低,还需大样本、质量较高的研究进行验证。
OBJECTIVE:To systematically evaluate the clinical efficacy and safety of traditional Chinese medicine combined with western medicine in the treatment of rheumatoid arthritis complicated with interstitial lung disease(RA-ILD).METHODS:Wanfang Data,VIP,CNKI,CBM,PubMed,Web of Science,Embase and the Cochrane Library were retrieved to collect the randomized controlled trial of traditional Chinese medicine combined with western medicine in the treatment of RA-ILD(the study group was treated with traditional Chinese medicine combined with western medicine,while the control group received western medicine)until Oct.15th,2021.Literature were collected and analyzed by RevMan 5.4 software,and the quality of literature was evaluated by the Cochrane collaborative network.RESULTS:A total of 17 studies were extracted,including 1254 patients.Compared with western medicine alone,traditional Chinese medicine combined with western medicine could effectively improve the total effective rate of patients with RA-ILD(RR=1.35,95%CI=1.24-1.47,P<0.00001),and improve the percentage of forced expiratory volume in one second to predicted value(FEV_(1)%)(MD=8.75,95%CI=3.98-13.51,P=0.0003),percentage of total lung volume to predicted value(TLC%)(MD=8.40,95%CI=5.76-11.04,P<0.00001),percentage of forced expiratory volume in one second to forced vital capacity(FEV_(1)/FVC)(MD=8.84,95%CI=3.88-13.80,P=0.0005),erythrocyte sedimentation rate(ESR)(MD=-5.85,95%CI=-9.22--2.49,P=0.0007)and rheumatoid factor(RF)(MD=-8.14,95%CI=-14.90--1.38,P=0.02),with statistically significant differences;yet there was no significant improvement in the percentage of forced vital capacity to predicted value(FVC%)(P>0.05).As for the percentage of carbon monoxide diffusing amount to predicted value(DLCO%)and C-reactive protein(CRP)levels,due to the high heterogeneity among different studies,only descriptive analysis was performed.The results showed that traditional Chinese medicine combined with western medicine could also improve DLCO%,CRP levels.There was no significant di
作者
罗成
吴聪
张宁
王玉光
LUO Cheng;WU Cong;ZHANG Ning;WANG Yuguang(Dept.of Respiratory,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China;Graduate School,Beijing University of Traditional Chinese Medicine,Beijing 100010,China)
出处
《中国医院用药评价与分析》
2022年第6期744-749,共6页
Evaluation and Analysis of Drug-use in Hospitals of China
基金
首都卫生发展科研专项项目(No.首发2020-2-2233)。
关键词
继发性间质性肺疾病
中医药治疗
类风湿关节炎
Meta分析
Secondary interstitial lung disease
Traditional Chinese medicine
Rheumatoid arthritis
Meta-analysis
