Liu Yong, Zhao Yi-Ding, Yan Xiao-Ning
The First Clinical Medical College of Shaanxi University of Traditional Chinese Medicine, Xianyang 712046, China.
Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi'an 710004, China.
Zhongguo Zhong Yao Za Zhi. 2018 May;43(9):1922-1933. doi: 10.19540/j.cnki.cjcmm.20180210.001.
To evaluate the clinical efficacy of traditional Chinese medicine Jianpi therapy in the treatment of atopic dermatitis. CNKI, Wanfang knowledge service platform, VIP journal database, Chinese biomedical literature database (CBM), PubMed, the Cochrane Library and EMbase database from inception to December 2017 were searched for the randomized controlled trials (RCTs) on traditional Chinese medicine Jianpi therapy in the treatment of atopic dermatitis. Literature selection and information extraction was completed and screened by two independent reviewers, and then the Cochrane recommended bias risk assessment method was used to evaluate the bias risk, and Review Manager 5.3 was used for the data analysis. Totally 37 clinical RCTs were included in this study, involving 2 973 patients. Analysis results showed that as compared with the western medicine, traditional Chinese medicine Jianpi therapy had higher clinical effective rate, with statistically significant difference (OR=4.05,95%CI[3.27, 5.03],<0.000 01); the improvement of score was more evident, including SCORAD score (WMD=-9.82,95%CI[-13.31,-6.33],<0.000 01), EASI score (WMD=-2.80,95%CI[-3.54,-2.07],<0.000 01), and itching VAS score (WMD=-0.79, 95%CI[-1.10,-0.47],<0.000 01)；the improvement of serum biochemical levels was more evident,including interferon-γ (IFN-γ) (WMD=1.75,95%CI[1.14,2.35],<0.000 01), interleukin-4 (IL-4) (WMD=-3.15,95%CI[-4.16,-2.15],<0.000 01), and Eosinophil direct count (EOS) (WMD=-0.11,95%CI[-0.20,-0.02], =0.02)；recurrence rate was significantly reduced (OR=0.36,95%CI[0.21,0.60],<0.000 1); and trial-related adverse events were reported in 11 RCTs. Studies have shown that traditional Chinese medicine Jianpi therapy had significantly higher clinical efficacy than western medicine in the treatment of atopic dermatitis. However, due to the publication bias and low quality bias of included RCTs in this study, more multicenter, high quality, large-sample, randomized double-blind controlled trials are needed to further demonstrate the conclusion.
评估中医健脾疗法治疗特应性皮炎的临床疗效。检索中国知网、万方知识服务平台、维普期刊数据库、中国生物医学文献数据库（CBM）、PubMed、考克兰图书馆和EMbase数据库，检索时间从建库至2017年12月，查找关于中医健脾疗法治疗特应性皮炎的随机对照试验（RCT）。由两名独立的评价员完成文献筛选和信息提取，然后采用考克兰推荐的偏倚风险评估方法评估偏倚风险，并使用Review Manager 5.3进行数据分析。本研究共纳入37项临床RCT，涉及2973例患者。分析结果显示，与西药相比，中医健脾疗法的临床有效率更高，差异有统计学意义（OR=4.05，95%CI[3.27，5.03]，P<0.000 01）；评分改善更明显，包括SCORAD评分（WMD=-9.82，95%CI[-13.31，-6.33]，P<0.000 01）、EASI评分（WMD=-2.80，95%CI[-3.54，-2.07]，P<0.000 01）和瘙痒视觉模拟评分（WMD=-0.79，95%CI[-1.10，-0.47]，P<0.000 01）；血清生化水平改善更明显，包括干扰素-γ（IFN-γ）（WMD=1.75，95%CI[1.14，2.35]，P<0.000 01）、白细胞介素-4（IL-4）（WMD=-3.15，95%CI[-4.16，-2.15]，P<0.000 01）和嗜酸性粒细胞直接计数（EOS）（WMD=-0.11，95%CI[-0.20，-0.02]，P=0.02）；复发率显著降低（OR=0.36，95%CI[0.21，0.60]，P<0.000 1）；11项RCT报告了与试验相关的不良事件。研究表明，中医健脾疗法治疗特应性皮炎的临床疗效显著高于西药。然而，由于本研究纳入的RCT存在发表偏倚和低质量偏倚，需要更多多中心、高质量、大样本、随机双盲对照试验来进一步证实该结论。
