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雷公藤提取物治疗类风湿关节炎:系统评价

[Tripterygium wilfordii extract for treating rheumatoid arthritis: systematic review].

作者信息

Jiang Quan, Cao Wei, Tang Xiaopo, Jiao Juan

机构信息

Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.

出版信息

Zhongguo Zhong Yao Za Zhi. 2009 Oct;34(20):2637-43.

Abstract

OBJECTIVE

To evaluate the efficacy and safety of Tripterygium wilfordii extract (TWE) in treating rheumatoid arthritis.

METHOD

Mainly using the simple methods from the International Cochrane Collaboration as systematic evaluation methods. Using Revman 4.2.5 which Cochrane Cooperation Web recommended to analysis. Using American College of Rheumatology (ACR) core set (ACR20, ACR50, and ACR70) of therapeutic efficacy measures which recommended by ACR, radiographic change of bone and the rate of inefficacy as efficacy methods. Dividing into placebo subgroup and DMARDs (disease modifying anti rheumatism drugs) subgroup according to different control treatments.

RESULT

A total of seven randomized controlled trials (RCTs) were collected. They are all of small sample size, six of which exist some methodological defects, resulting in many possible biases. As evaluated by ACR20/50/70, TWE was as effective as DMARDs in reducing number of swelling joints, level of C-reactive protein (CRP), and was more effective than DMARDs in reducing erythrocyte sedimentation rate (ESR) (P <0.01). While TWE was no effect in delaying bone destruction. The incidence of adverse reactions of TWE is higher than DMARDs.

CONCLUSION

TWE can be used as an alternative medicine in treating RA. But owing to lacking of data from high-quality RCTs, however, the efficacy and safety of TWE are desired for further exploration.

摘要

目的

评估雷公藤提取物(TWE)治疗类风湿关节炎的疗效和安全性。

方法

主要采用国际Cochrane协作网的简单方法作为系统评价方法。使用Cochrane协作网推荐的Revman 4.2.5进行分析。采用美国风湿病学会(ACR)推荐的治疗疗效评估核心指标集(ACR20、ACR50和ACR70)、骨影像学改变及无效发生率作为疗效评价方法。根据不同对照治疗分为安慰剂亚组和改善病情抗风湿药(DMARDs)亚组。

结果

共纳入7项随机对照试验(RCT)。均为小样本量,其中6项存在一些方法学缺陷,导致存在诸多可能的偏倚。以ACR20/50/70评估,TWE在减少关节肿胀数、降低C反应蛋白(CRP)水平方面与DMARDs疗效相当,在降低红细胞沉降率(ESR)方面比DMARDs更有效(P<0.01)。而TWE在延缓骨质破坏方面无效。TWE不良反应发生率高于DMARDs。

结论

TWE可作为治疗类风湿关节炎的替代药物。但由于缺乏高质量RCT数据,TWE的疗效和安全性仍有待进一步探索。

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