口服中药联合窄谱中波紫外线治疗寻常型银屑病的疗效：一项系统评价与Meta分析
Efficacy of combining oral Chinese herbal medicine and NB-UVB in treating psoriasis vulgaris: a systematic review and meta-analysis.
作者信息
Yang Lihong, Zhang Claire Shuiqing, May Brian, Yu Jingjie, Guo Xinfeng, Zhang Anthony Lin, Xue Charlie Changli, Lu Chuanjian
机构信息
Evidence Based Medicine and Clinical Research Service Group, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China ; The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China ; Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 China.
China-Australia International Research Centre for Chinese Medicine, School of Health Sciences, RMIT Health Innovations Research Institute, RMIT University, PO Box 71, Bundoora, Melbourne, VIC 3083 Australia.
出版信息
Chin Med. 2015 Sep 26;10:27. doi: 10.1186/s13020-015-0060-y. eCollection 2015.
BACKGROUND
The combination of a Chinese herbal medicine (CHM) bath and narrowband ultraviolet B (NB-UVB) improved the efficacy of NB-UVB treatment of psoriasis vulgaris, but bath therapy is inconvenient. Oral CHM plus NB-UVB has been tested in clinical practice. This study aims to evaluate whether adding oral CHM could be beneficial for NB-UVB therapy by a systematic review and meta-analysis.
METHODS
Nine English and Chinese databases were searched from their inception to April 2014. Randomized controlled trials (RCTs) comparing the combination of orally administered CHM and NB-UVB with that of CHM placebo and NB-UVB or NB-UVB alone for treating psoriasis vulgaris and reporting Psoriasis Area Severity Index (PASI) outcomes were included. A systematic review, meta-analysis, risk of bias assessment and the GRADE assessment were conducted in accordance with Cochrane Collaboration methodology to assess the evidence for efficacy outcome. Data were analyzed in RevMan5.2.
RESULTS
Eighteen eligible RCTs (n = 1416) were included for systematic review, and 17 (n = 1342) of them were included in meta-analysis. Risk of bias in terms of blinding was high and so was in publication bias. Quality of evidence was low according the GRADE assessment. PASI-60 or above [risk ratio (RR) = 1.35, 95 % confidence interval (CI) 1.26-1.45, I(2) = 5 %, number needed to treat = 4.27] and PASI-90 or above (RR = 1.71, 95 % CI 1.45-2.01, I(2) = 0 %, number needed to treat = 5.92) were higher in the intervention group. The combination treatment conferred a 24 % benefit of PASI-60 or above (83 vs 59 %, RR = 1.35, 95 % CI 1.26-1.45, P < 0.01). The incidence of NB-UVB-induced adverse events was lower in the intervention group (95/464 vs 123/428, RR = 0.66, 95 % CI 0.46-0.96, P < 0.01). Mild gastrointestinal reactions (2.87 %) and liver function impairments (0.68 %) were reported in the intervention group. No serious adverse events were reported.
CONCLUSION
The orally administrated CHM combined with NB-UVB in treating psoriasis vulgaris showed improved efficacy but quality of evidence was low.
背景
中药药浴联合窄谱中波紫外线（NB - UVB）可提高NB - UVB治疗寻常型银屑病的疗效，但药浴疗法不便。口服中药联合NB - UVB已在临床实践中进行了试验。本研究旨在通过系统评价和荟萃分析评估添加口服中药对NB - UVB治疗是否有益。
方法
检索了9个英文和中文数据库，检索时间从建库至2014年4月。纳入比较口服中药联合NB - UVB与中药安慰剂联合NB - UVB或单独使用NB - UVB治疗寻常型银屑病并报告银屑病面积和严重程度指数（PASI）结果的随机对照试验（RCT）。按照Cochrane协作网方法进行系统评价、荟萃分析、偏倚风险评估和GRADE评估，以评估疗效结果的证据。数据在RevMan5.2中进行分析。
结果
18项符合条件的RCT（n = 1416）纳入系统评价，其中17项（n = 1342）纳入荟萃分析。在盲法方面偏倚风险高，发表偏倚也是如此。根据GRADE评估，证据质量低。干预组达到PASI - 60及以上[风险比（RR）= 1.35，95%置信区间（CI）1.26 - 1.45，I² = 5%，需治疗人数 = 4.27]和PASI - 90及以上（RR = 1.71，95% CI 1.45 - 2.01，I² = 0%，需治疗人数 = 5.92）的比例更高。联合治疗使达到PASI - 60及以上的益处增加24%（83%对59%，RR = 1.35，95% CI 1.26 - 1.45，P < 0.01）。干预组NB - UVB诱导的不良事件发生率较低（95/464对123/428，RR = 0.66，95% CI 0.46 - 0.96，P < 0.01）。干预组报告有轻度胃肠道反应（2.87%）和肝功能损害（0.68%）。未报告严重不良事件。
结论
口服中药联合NB - UVB治疗寻常型银屑病显示出疗效提高，但证据质量低。
Zotero 插件