Zhang Xiao-Meng, Zhang Bing, Li Fan, Tian Zhi-Ping
Beijing University of Chinese Medicine, Beijing 100029, China.
Zhongguo Zhong Yao Za Zhi. 2018 Jan;43(2):227-233. doi: 10.19540/j.cnki.cjcmm.20171106.005.
To analyze the efficacy and safety of the combination therapy of Aconitum and Western medicine in the treatment of rheumatoid arthritis (RA) by Meta-analysis, and provide evidence for its clinic application for RA. The random clinical trials (RCTs) regarding the combination therapy for treating RA were retrieved in the database of China National Knowledge Infrastructure database, China Science and Technology Journal database, WanFang, Chinese Biomedical Medical Database, PubMed, and Cochrane Library up to July 2017. According to the given inclusion criteria, 8 RCTs involving 659 participants were included, and the included RCTs could be further divided into three subgroups according to the herb type, which were Aconiti Radix (Chuanwu) subgroup (6RCTs), Aconiti Kusnezoffii Radix (Caowu) subgroup (1RCT), and Chuanwu-Caowu subgroup (1RCT). The Meta-analysis results indicated that as compared with Western medicine, the combined use of Aconitum and Western medicine, no matter Chuanwu, Caowu or Chuanwu-Caowu subgroups, could improve the total effective rate of RA (6RCTs, RR=1.19, 95%CI [1.10, 1.28], <0.000 01), (1 RCT, RR=1.43, 95%CI [1.18, 1.73], =0.000 2), (1 RCT, RR=1.27, 95%CI [1.02, 1.58], =0.03) respectively. The combined use of Aconitum and Western medicine was also effective on the number of joint swelling, duration of morning stiffness, patients' handgrip, and the erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor. However, its action was not significant on joint tenderness. And also, in the included RCTs, there were 34 cases of adverse drug reactions/events (ADR/ADE) in the Chuanwu subgroup, while 86 cases in the Western medicine control group. The ADR/ADE incidence was even more lower in Chuanwu-Caowu subgroup, but no difference between Caowu subgroup and Western medicine group. Based on the included RCTs, the combined use of Aconitum and Western medicine could achieve more satisfying efficacy and lower ADRs incidence for RA as compared with Western medicine alone. However, due to the limitation in the not-high quality of included RCTs and the lack of large-scale multi-center research, the results still need to be further validated in the clinic application.
通过Meta分析探讨中药附子与西药联合治疗类风湿关节炎（RA）的有效性和安全性，为其临床应用提供依据。检索中国知网、维普、万方、中国生物医学文献数据库、PubMed及Cochrane图书馆中截至2017年7月关于附子联合西药治疗RA的随机对照试验（RCT）。根据纳入标准，纳入8项RCT，共659例患者，纳入的RCT根据中药类型可进一步分为3个亚组，即川乌亚组（6项RCT）、草乌亚组（1项RCT）和川乌-草乌亚组（1项RCT）。Meta分析结果显示，与西药相比，附子联合西药，无论川乌、草乌还是川乌-草乌亚组，均可提高RA的总有效率（6项RCT，RR=1.19，95%CI[1.10，1.28]，P<0.000 01），（1项RCT，RR=1.43，95%CI[1.18，1.73]，P=0.000 2），（1项RCT，RR=1.27，95%CI[1.02，1.58]，P=0.03）。附子联合西药对关节肿胀数、晨僵时间、患者握力以及红细胞沉降率、C反应蛋白和类风湿因子也有疗效，但对关节压痛作用不明显。此外，纳入的RCT中，川乌亚组有34例药物不良反应/事件（ADR/ADE），西药对照组有86例。川乌-草乌亚组ADR/ADE发生率更低，草乌亚组与西药组无差异。基于纳入的RCT，附子联合西药治疗RA较单用西药疗效更佳且ADR发生率更低。然而，由于纳入的RCT质量不高且缺乏大规模多中心研究，结果仍需在临床应用中进一步验证。
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