依托考昔治疗急性痛风性关节炎疗效及安全性的meta分析

发布时间：2018-04-12 15:25

本文选题：依托考昔 + 急性痛风　；参考：《河北医科大学》2016年硕士论文

【摘要】：目的:非甾体抗炎药(Nonsteroidal Anti-inflammatory Drugs,NSAIDs)的应用已有上百年历史,有数据证明,在中国,NSAIDs销售量仅次于抗感染药物,居第二位。NSAIDs通过抑制环氧化酶(Cyclooxygenase,COX)发挥作用,在急性痛风性关节炎中的应用较为广泛,非选择性NSAIDs疗效确切,但不良反应较多。随着选择性COX-2抑制剂在临床中的应用,国内外不乏针对其与非选择性NSAIDs疗效和安全性的临床随机对照试验(Randomized Controlled Trial,RCT)。本文主要评价了依托考昔对比吲哚美辛、双氯芬酸钠、塞来昔布、美洛昔康治疗急性痛风性关节炎的疗效与安全性。方法:运用计算机检索中国知网、万方、维普、Cochrane图书馆、Em Base、OVID、Pub Med数据库中依托考昔的临床随机对照试验。2名研究者独立对文献进行阅读筛选,评价质量并提取数据。应用Cochrane协作网提供的Rev Man 5.3进行meta分析。结果:被纳入研究的文献总共有15篇。对于急性痛风性关节炎的疼痛缓解,视觉模拟评分(Visual Analogue Scale,VAS)、5分Likert量表及总有效率三种疼痛评分方法均支持依托考昔优于其它NSAIDs[SMD=-2.49,95%CI[-3.90,-1.08],P=0.0005;MD=-0.19,95%CI[-0.26,-0.11],P0.00001;OR=6.24,95%CI[1.75,22.27],P=0.005]。对于白细胞计数和C反应蛋白的下降依托考昔优于其它NSAIDs[SMD=-1.41,95%CI[-2.44,-0.39],P=0.007;MD=-0.91,95%[-1.74,-0.08],P=0.03]。依托考昔降尿酸作用优于非选择性NSAIDs,对比其它选择性COX-2抑制剂,没有显著性差异[MD=24.64,95%CI[2.69,46.59],P=0.03;MD=-1.37,95%CI[-20.23,17.49],P=0.89]。在不良反应上,依托考昔的总不良反应发生率较低OR=0.43,95%CI[0.33,0.56],P0.00001。进一步与非选择性NSAIDs相比,依托考昔总不良反应的发生较少OR=0.36,95%CI[0.26,0.50],P0.00001。而与其它选择性COX-2抑制剂相比,无显著性差异OR=0.65,95%CI[0.40,1.03],P=0.07。依托考昔有着更少的胃肠道副作用OR=0.33,95%CI[0.23,0.49],P0.00001。在心血管副作用上,依托考昔与其它NSAIDs无显著性差异OR=0.77,95%CI[0.44,1.34],P=0.35。结论:依托考昔用于治疗急性痛风性关节炎有着良好的疗效,并且安全性高,但仍需更多的随机对照试验证实其对心血管副作用的影响。
[Abstract]:Objective: nonsteroidal Anti-inflammatory drugs (NSAIDs) have been used for more than 100 years. Data show that the sales volume of NSAIDs in China is second only to anti-infective drugs, and it is the second place of NSAIDs to play a role by inhibiting cyclooxygenase cyclooxygenase (COXs).It is widely used in acute gouty arthritis. Non-selective NSAIDs is effective, but there are more adverse reactions.With the application of selective COX-2 inhibitors in clinical practice, there is no shortage of randomized Controlled trials at home and abroad aimed at the efficacy and safety of NSAIDs and non-selective NSAIDs.This paper mainly evaluated the efficacy and safety of Ecoxim, diclofenac sodium, celecoxib and meloxicam in the treatment of acute gouty arthritis.Methods: a computer-based search was conducted in the Em Base OVIDPub Med database of China's Zhiwang, Wanfang and Wipline Cochrane Library. Two hundred and two researchers independently selected the literature, evaluated the quality and extracted the data, relying on the clinical randomized controlled trial of Cauxime.The meta analysis was carried out with Rev Man 5.3 provided by Cochrane cooperation network.Results: a total of 15 articles were included in the study.In adverse reactions, the incidence of total adverse reactions was lower than that of OR0.43 95 CI [0.33 卤0.56] P 0.00001.Further more, compared with non-selective NSAIDs, the incidence of total adverse reactions was less than 0.36% CI [0.26 0.50] P 0.00001.Compared with other selective COX-2 inhibitors, there was no significant difference in CI (0.401.03).Ecoxim has fewer gastrointestinal side effects: 0.33 / 95 CI [0.23 / 0.49] P 0.00001.In cardiovascular side effects, there was no significant difference in cardiovascular side effects between the two groups. There was no significant difference between the two groups in the cardiovascular side effects. There was no significant difference between the two groups in the cardiovascular side effects. There was no significant difference between the two groups in the cardiovascular side effects.Conclusion: relying on coxa has good curative effect and high safety in treating acute gouty arthritis, but more randomized controlled trials are needed to prove its effect on cardiovascular side effects.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R589.7

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