四妙散加减口服配合中药外敷治疗痛风性关节炎的meta分析

发布时间：2018-04-21 00:16

本文选题：四妙散 + 中药外敷　；参考：《辽宁中医药大学》2017年硕士论文

【摘要】：目的:对四妙散加减口服配合中药外敷治疗痛风性关节炎的多项独立研究进行meta分析,通过探讨其临床疗效、不良反应及对CRP、ESR、WBC、血尿酸的影响,为痛风性关节炎的临床治疗及及研究提供循证证据。资料与方法:确定纳入排除标准,制定检索式,全面检索CNKI中国知网、万方数据、维普中文科技期刊数据库、中国生物医学文献数据库CBM、Pub Med、The Cochrane Library数据库。检索年限为建库至2016年12月。由两名评价员按纳入排除标准对四妙散加减口服配合中药外敷治疗痛风性关节炎的随机对照试验进行初筛、对文献质量进行评价并完成数据提取。使用Revman 5.3软件对数据进行meta分析。结果:共纳入18篇随机对照试验,共治疗1335名患者。试验组均使用四妙散加减口服配合中药外敷,对照组均使用西药,其中5篇单用秋水仙碱,7篇单用NSAIDs,3篇合用秋水仙碱及NSAIDs,3篇急性期使用秋水仙碱,缓解期使用别嘌呤醇。1.共18篇文献提及总有效率,meta分析结果显示:RR=1.16,95%CI[1.08,1.23],Z=4.43(P0.01)2.共14篇提及以血尿酸为观察指标,meta分析示:SMD=-1.97,95%CI[-2.66,-1.28],Z=5.59(P0.01)3.共9篇提及以ESR为观察指标,meta分析显示:SMD=-0.82,95%CI[-1.23,-0.41],Z=3.96(P0.01)4.共7篇提及以CRP为观察指标,meta分析示:SMD=-0.31,95%CI[-0.69,0.06],Z=1.63(P=0.10)5.共2篇提及以WBC为观察指标,meta分析示:SMD=-0.73,95%CI[-0.95,-0.51],Z=6.60(P0.01)6.共11篇文献提及不良反应,meta分析示:RR=0.08,95%CI[0.04,0.14],Z=8.47(P0.01)。结论:1.四妙散加减口服配合中药外敷治疗痛风性关节炎的总有效率优于单纯应用西药。2.四妙散加减口服配合中药外敷可有效降低痛风性关节炎患者的血尿酸、ESR、WBC。3.不能说明四妙散加减口服配合中药外敷对于降低痛风性患者的CRP的作用优于单纯应用西药。4.四妙散加减口服配合中药外敷不良反应发生少于单纯应用西药,值得推广使用。
[Abstract]:Objective: to investigate the clinical efficacy, adverse reactions and effects of SIMAO San plus or subtractive oral administration combined with external application of traditional Chinese medicine on gouty arthritis by meta analysis, and to investigate the effects of the two methods on the treatment of gouty arthritis, including the clinical efficacy, adverse reactions and the effects on the serum uric acid (uric acid) in patients with gouty arthritis. To provide evidence-based evidence for the clinical treatment and research of gouty arthritis. Materials and methods: the criteria of inclusion and exclusion were determined, the retrieval form was formulated, the CNKI China knowledge Network, the Wanfang data, the Weipu Chinese Science and Technology Journal Database, the Chinese Biomedical Literature Database CBM Pub Medbin and the Cochrane Library database were searched in an all-round way. The retrieval period is to build the database until December 2016. According to the exclusion criteria, two evaluators conducted a randomized controlled trial on the treatment of gouty arthritis with the addition and subtraction of Simiao San and external application of traditional Chinese medicine. The literature quality was evaluated and the data were extracted. The data were analyzed by meta using Revman 5.3 software. Results: a total of 1335 patients were treated in 18 randomized controlled trials. All the experimental groups were treated with Simiao powder plus or minus oral administration combined with external application of traditional Chinese medicine, while the control group were all treated with western medicine. Among them, 5 were treated with colchicine alone, 7 with NSAIDsL and 3 with colchicine and NSAIDs3 with colchicine in acute phase, and allopurinol with allopurinol. 1 in remission period. A total of 18 articles mentioned the total effective rate. The results of meta analysis showed that 1: RRN 1.16 and 95 CI [1.08 / 1.23] ZH4. 43 / P0. 01 / 2. A total of 14 articles mentioned that the blood uric acid was used as an index of observation. The analysis of meta showed that: SMD-1.9795 CI [-2.66 ~ (-1.28)] ~ (-5.59) (P _ (0.01)) ~ (3). A total of 9 references were made using ESR as an index of observation. The results of meta analysis showed that: SMD-0.82C95 [-1.23 + -0.41] [-1.23 -0.41] ZH3.96 (P0.01). A total of 7 references were made using CRP as an index of observation. The analysis of meta showed that: SMD-0.31 / 95: CI [-0.69 ~ 0.06] Z 1.63 ~ 0.10 ~ (5). A total of 2 articles mentioned that the WBC was used as the observation index. The analysis of meta showed that: SMD-0.7395 (CI = -0.95U -0.51). A meta analysis of adverse reactions mentioned in 11 articles showed that 1% RRV 0.0895 CI [0.04 0. 14] was 8.47% P0.01C. Conclusion 1. The total effective rate of addition and subtraction of Simiao Powder combined with external application of traditional Chinese medicine in the treatment of gouty arthritis was better than that of western medicine alone. The addition and subtraction of Simiao Powder combined with external application of traditional Chinese medicine can effectively reduce the blood uric acid in patients with gouty arthritis. It can not be explained that the effect of addition and subtraction of Simiao Powder combined with external application of traditional Chinese medicine on reducing CRP in patients with gouty is better than that of western medicine alone. 4. Addition and subtraction of Simiao Powder combined with external application of traditional Chinese medicine have less adverse reactions than western medicine alone, so it is worth popularizing.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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