Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
People's Hospital of Ningxiang City, Ningxiang City, Hunan Province, China.
Oxid Med Cell Longev. 2021 Oct 7;2021:3302886. doi: 10.1155/2021/3302886. eCollection 2021.
To explore the efficacy of antioxidative stress therapy on oxidative stress levels in rheumatoid arthritis (RA) by a systematic review and meta-analysis of randomized controlled trials.
Chinese and English databases such as PubMed, Embase, China National Knowledge Infrastructure (CNKI), and China Biomedical Literature were searched, mainly searching for clinical randomized controlled trials of antioxidant therapy for rheumatoid arthritis. The search time is from the establishment of the database to July 2021. Two researchers independently carried out literature search, screening, and data extraction. The bias risk tool provided by the Cochrane Collaboration was used to evaluate the bias risk of all the included literature, and the RevMan 5.3 software was used for meta-analysis.
A total of 24 RCTs (28 records) and 1277 participants were included. The time span of randomized controlled trials (RCTs) is from 1986 to 2020. These RCTs involve 14 types of antioxidants or antioxidant therapies, and these therapies have varying degrees of improvement on oxidative stress in RA patients. The summary results showed that the MDA in the experiment group is lower (SMD -0.82, 95% CI -1.35 to -0.28, = 0.003). The difference of TAC, SOD, NO, GPx, CAT, and GSH between two groups was of no statistical significance (TAC (SMD 0.27, 95% CI -0.21 to 0.75, = 0.27), SOD (SMD 0.12, 95% CI -0.16 to 0.40, = 0.41), NO (SMD -2.03, 95% CI -4.22 to 0.16, = 0.07), GPx (SMD 0.24, 95% CI -0.07 to 0.54, = 0.13), CAT (SMD 2.95, 95% CI -2.6 to 8.51, = 0.30), and GSH (SMD 2.46, 95% CI -0.06 to 4.98, = 0.06)). For adverse events, the summary results showed that the difference was of no statistical significance (RR 1.16, 95% CI 0.79 to 1.71, = 0.45). In addition, antioxidant therapy has also shown improvement in clinical efficacy indexes (number of tender joints, number of swollen joints, DAS28, VAS, and HAQ) and inflammation indexes (ESR, CRP, TNF-, and IL6) for RA patients.
The existing evidence shows potential benefits, mainly in reducing MDA and increasing TAC and GSH in some subgroups. However, more large samples and higher quality RCTs are needed to provide high-quality evidence, so as to provide more clinical reference information for the antioxidant treatment of RA.
通过对随机对照试验的系统评价和荟萃分析，探讨抗氧化应激疗法对类风湿关节炎（RA）患者氧化应激水平的疗效。
检索PubMed、Embase、中国知网（CNKI）和中国生物医学文献数据库等中英文数据库，主要检索抗氧化剂治疗类风湿关节炎的临床随机对照试验。检索时间为数据库建立至 2021 年 7 月。两名研究人员独立进行文献检索、筛选和数据提取。使用 Cochrane 协作提供的偏倚风险工具评估所有纳入文献的偏倚风险，并使用 RevMan 5.3 软件进行荟萃分析。
共纳入 24 项 RCT（28 篇记录）和 1277 名参与者。随机对照试验的时间跨度为 1986 年至 2020 年。这些 RCT 涉及 14 种抗氧化剂或抗氧化疗法，这些疗法对 RA 患者的氧化应激有不同程度的改善。汇总结果显示，实验组 MDA 较低（SMD-0.82，95%CI-1.35 至-0.28， =0.003）。两组间 TAC、SOD、NO、GPx、CAT 和 GSH 的差异无统计学意义（TAC（SMD0.27，95%CI-0.21 至 0.75， =0.27），SOD（SMD0.12，95%CI-0.16 至 0.40， =0.41），NO（SMD-2.03，95%CI-4.22 至 0.16， =0.07），GPx（SMD0.24，95%CI-0.07 至 0.54， =0.13），CAT（SMD2.95，95%CI-2.6 至 8.51， =0.30），和 GSH（SMD2.46，95%CI-0.06 至 4.98， =0.06））。对于不良事件，汇总结果显示差异无统计学意义（RR1.16，95%CI0.79 至 1.71， =0.45）。此外，抗氧化治疗还显示出改善 RA 患者的临床疗效指标（压痛关节数、肿胀关节数、DAS28、VAS 和 HAQ）和炎症指标（ESR、CRP、TNF-和 IL6）的作用。
现有证据表明具有潜在益处，主要表现在降低 MDA 和增加 TAC 和 GSH 方面，但仍需要更多大样本、高质量的 RCT 提供高质量证据，从而为 RA 的抗氧化治疗提供更多的临床参考信息。
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