健脾益气固表法治疗慢性荨麻疹的系统评价

发布时间：2019-05-18 00:37

【摘要】：目的：系统评价健脾益气固表法治疗慢性荨麻疹的疗效、复发情况及安全性,并进行健脾益气固表法治疗慢性荨麻疹的用药规律的挖掘与分析,为临床合理用药及进一步开展相关研究提供按照循证医学方法评估过的证据。方法：检索Cochrane library、Pub Med、Embase、和中国知网(CNKI)、维普数据(CQVIP)、万方(Wanfang)、中国生物医学文献数据库(CBM),时间截止至2015年7月10日。检索策略主要从“疾病(荨麻疹)”、“干预措施(如中医药)”、“研究类型(如随机对照试验)”三个方面制定,纳入健脾益气固表法治疗慢性荨麻疹的临床随机对照研究。根据Cochrane Handbook 5.1.0,评价研究质量,进行定性或定量合成分析。运用Revman5.3进行数据统计分析。并采用“中医传承辅助系统v2.5”对基于健脾益气固表法的方药治疗慢性荨麻疹用药规律进行归纳,包括用药频次统计、基于关联规则的方剂组方规律研究以及新方的演化。结果：最终纳入系统评价的研究共有17个,15个研究进入Mera分析。17个研究共涉及1712例患者,其中进入Meta分析的15个研究涉及1517例患者。Meta分析提示健脾益气固表法治疗慢性荨麻疹疗效优于对照组(P＜0.05)或与目前西医一线治疗疗效相当(P＞0.05),且健脾益气固表法治疗慢性荨麻疹停药后复发率较对照组低,结果具有统计学意义(P＜0.05)。其中,基于健脾益气固表法使用单纯中药治疗慢性荨麻疹的疗效与单纯抗组胺药治疗的疗效相当(RR：1.03；95% CI：0.92-1.15),复发率治疗组较对照组低(RR：0.37；95% CI：0.24-0.59)；基于健脾益气固表法使用中药内服联合抗组胺药治疗慢性荨麻疹有效率高于单纯抗组胺药治疗的有效率(RR：1.21；95% CI：1.15-1.28),且复发率显示中药内服联合抗组胺药治疗慢性荨麻疹停药后复发率低于单独使用抗组胺药治疗慢性荨麻疹(RR：0.32；95% CI：0.25-0.41)。基于中医传承辅助平台,用药规律分析提示使用频次最高的3味中药是黄芪、白术、防风；最常用的药对是“黄芪和防风”、“黄芪和白术”、“白术和防风”。演化出治疗慢性荨麻疹的2个新处方,分别是“白蒺藜、甘草、首乌藤、当归、荆芥、白芍”,“当归、白术、白芍、甘草、川芎、僵蚕”。结论：健脾益气固表法治疗慢性荨麻疹疗效优于对照组或与目前西医一线治疗疗效相当,基于健脾益气固表法的治疗组停药后复发率低于对照组停药后的复发率。然而,由于纳入研究的设计可能存在方法学的缺陷,对于结果的解释需要慎重。用药规律分析结果可作为临床用药和研究的参考。
[Abstract]:Objective: to systematically evaluate the efficacy, recurrence and safety of Jianpi Yiqi solid surface method in the treatment of chronic urticaria, and to excavate and analyze the drug use law of Jianpi Yiqi solid surface method in the treatment of chronic urticaria. It provides evidence that evidence-based medicine has been evaluated according to evidence-based medicine for rational clinical drug use and further research. Methods: the (CBM), time of Cochrane library,Pub Med,Embase, and China knowledge Network (CNKI), Winfang (Wanfang), China Biomedical Literature Database was searched until July 10, 2015. The retrieval strategy was mainly formulated from three aspects: "disease (urticaria)", "intervention measures (such as traditional Chinese medicine)" and "types of research (such as randomized controlled trials)". A clinical randomized controlled study on the treatment of chronic urticaria with invigorating spleen and invigorating qi and fixing surface was included in this study. According to Cochrane Handbook 5.1.0, the research quality was evaluated and qualitative or quantitative synthetic analysis was carried out. Revman5.3 is used for data statistical analysis. The law of drug use in the treatment of chronic urticaria based on Jianpi Yiqi and solid surface method was summarized by using "Chinese medicine inheritance auxiliary system v2.5", including the statistics of drug frequency, the study of prescription rule based on association rules and the evolution of new prescription. Results: a total of 17 studies were eventually included in the systematic evaluation, 15 of which were involved in Mera analysis. 17 studies involved 1712 patients. Among them, 1517 patients were involved in the 15 studies of Meta analysis. Meta-analysis showed that the curative effect of invigorating spleen, replenishing qi and fixing surface in the treatment of chronic urticaria was better than that of the control group (P < 0.05) or similar to that of the current first-line treatment of western medicine (P > 0.05). The recurrence rate of chronic urticaria treated with Jianpi Yiqi solid surface method was lower than that of the control group, and the results were statistically significant (P < 0.05). Among them, the efficacy of traditional Chinese medicine in the treatment of chronic urticaria based on Jianpi Yiqi solid surface method is as good as that of antihistamine alone (RR:1.03;). 95% CI:0.92-1.15), the recurrence rate in the treatment group was lower than that in the control group (RR:0.37;95% CI:0.24-0.59). Based on Jianpi Yiqi solid surface method, the effective rate of traditional Chinese medicine combined with antihistamine in the treatment of chronic urticaria was higher than that of antihistamine alone (RR:1.21;). 95% CI:1.15-1.28), and the recurrence rate showed that the recurrence rate after taking traditional Chinese medicine combined with antihistamine drugs in the treatment of chronic urticaria was lower than that in the treatment of chronic urticaria (RR:0.32;) treated with antihistamine alone. 95% CI:0.25-0.41). Based on the inheritance auxiliary platform of traditional Chinese medicine, it is suggested that the three most frequently used traditional Chinese medicines are Astragalus membranaceus, Atractylodes macrocephala and Fangfeng, and the most commonly used drugs are Astragalus membranaceus and Fangfeng, Astragalus membranaceus and Atractylodes macrocephala, Atractylodes macrocephala and Fangfeng. Two new prescriptions for the treatment of chronic urticaria were "Tribulus terrestris, Glycyrrhiza uralensis Fisch, Radix Polygoni Multiflori, Radix angelicae Sinensis, Tripterygium wilfordii, Radix Paeoniae Rubra", "Angelica sinensis, Atractylodes macrocephala, Radix Paeoniae Alba, Glycyrrhiza uralensis Fisch, Ligusticum Conclusion: the curative effect of invigorating spleen, replenishing qi and fixing surface in the treatment of chronic urticaria is better than that of the control group or the curative effect of the first line treatment of western medicine at present. The recurrence rate of the treatment group based on the method of invigorating spleen and replenishing qi is lower than that of the control group. However, due to the methodological defects of the design included in the study, the interpretation of the results needs to be careful. The results of drug use law analysis can be used as a reference for clinical drug use and research.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R275.9

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