雷公藤对寻常型银屑病的疗效与安全性：一项随机对照试验的系统评价与Meta分析
Efficacy and Safety of Tripterygium Wilfordii Hook F on Psoriasis Vulgaris: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
作者信息
Lv Meng, Deng Jingwen, Tang Nan, Zeng Yuejin, Lu Chuanjian
机构信息
Department of Dermatology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China.
Psoriasis Clinical and Basic Research Team, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, China.
出版信息
Evid Based Complement Alternat Med. 2018 Apr 22;2018:2623085. doi: 10.1155/2018/2623085. eCollection 2018.
BACKGROUND
Psoriasis is a chronic autoimmune-mediated skin disease that is characterized by persistent localized erythematous scaly plaque. Tripterygium wilfordii Hook F (TwHF), a well-known Chinese medicine that has been used for centuries in China to treat immune diseases, inflammation, and tumor, is accompanied by a degree of toxic effects. Its clinical efficacy and safety on psoriasis are incompletely understood.
AIM
To summarize evidence concerning the efficacy and safety of TwHF in treating psoriasis. EMBASE, Ovid MEDLINE, PubMed, Web of Science, Springer, Cochrane Library, CNKI, CBM, Wanfang, and VIP database were searched up to October 2017. The included literature was assessed and extracted by two independent reviewers. To enhance the available evidence, a systematic review was performed to examine all relevant published literature relating to randomized controlled trials (RCTs) of TwHF. Relative ratios (RRs) and 95% confidence intervals (CIs) were calculated, and a meta-analysis was conducted with RevMan 5.3 software.
RESULTS
Twenty eligible RCTs with 1872 participants were included for systematic review and meta-analysis. Studies were assessed using the Cochrane risk of bias tool. The meta-analysis of add-on effect of TwHF conferred benefit for psoriasis: combination treatment with compound glycyrrhizin (four studies, OR = 0.34, 95% CI 0.22-0.52, < 0.00001, = 0%), combination treatment with acitretin (three studies, OR = 0.25, 95% CI 0.10-0.63, = 0.003, = 50%), and combination treatment with compound amino-polypeptide tablet (three studies, OR = 0.37, 95% CI 0.22-0.63, = 0.0002, = 0%).
CONCLUSIONS
Despite several mild side effects of TwHF, there is evidence that TwHF is an effective therapy for psoriasis. However, the conclusions are limited by the small number of included trials. More well-designed RCTs with extensive follow-up periods are warranted to clarify the effects and safety of TwHF in treating psoriasis.
TRIAL REGISTRATION
This review was registered in the International Prospective Register of Systematic Reviews (CRD42016041363).
背景
银屑病是一种慢性自身免疫介导的皮肤病，其特征为持续性局限性红斑鳞屑斑块。雷公藤多苷（TwHF）是一种在中国已使用数百年用于治疗免疫疾病、炎症和肿瘤的著名中药，但伴有一定程度的毒性作用。其对银屑病的临床疗效和安全性尚未完全明确。
目的
总结雷公藤多苷治疗银屑病的疗效和安全性证据。检索了截至2017年10月的EMBASE、Ovid MEDLINE、PubMed、Web of Science、Springer、Cochrane图书馆、中国知网、中国生物医学文献数据库、万方数据库和维普数据库。纳入的文献由两名独立 reviewers 进行评估和提取。为加强现有证据，进行了一项系统评价，以审查所有与雷公藤多苷随机对照试验（RCTs）相关的已发表文献。计算相对比值（RRs）和95%置信区间（CIs），并使用RevMan 5.3软件进行荟萃分析。
结果
纳入20项符合条件的RCTs，共1872名参与者进行系统评价和荟萃分析。使用Cochrane偏倚风险工具对研究进行评估。雷公藤多苷附加效应的荟萃分析显示对银屑病有益：与复方甘草酸苷联合治疗（4项研究，OR = 0.34，95%CI 0.22 - 0.52，<0.00001，I² = 0%），与阿维A联合治疗（3项研究，OR = 0.25，95%CI 0.10 - 0.63，P = 0.003，I² = 50%），以及与复方氨基酸多肽片联合治疗（3项研究，OR = 0.37，95%CI 0.22 - 0.63，P = 0.0002，I² = 0%）。
结论
尽管雷公藤多苷有一些轻微副作用，但有证据表明其是治疗银屑病的有效疗法。然而，这些结论受到纳入试验数量较少的限制。需要更多设计良好、随访期长的RCTs来阐明雷公藤多苷治疗银屑病的效果和安全性。
试验注册
本评价已在国际前瞻性系统评价注册库（CRD42016041363）注册。
Zotero 插件