秋水仙碱联合疗法可提高关节炎患者的治疗耐受性：一项系统评价与荟萃分析。
Colchicine combination therapy increases treatment tolerance in patients with arthritis: A systematic review and meta-analysis.
作者信息
Zhao Changwei, Hao Xiaogang, Cai Wenjun, Zeng Ling-Feng, Zhao Wenhai, Li Xiangxin
机构信息
Changchun University of Chinese Medicine, Changchun, China.
The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China.
出版信息
PLoS One. 2024 Dec 30;19(12):e0316126. doi: 10.1371/journal.pone.0316126. eCollection 2024.
BACKGROUND
Arthritis seriously affects people's quality of life, and there is an urgent clinical need to improve the efficacy of medications as well as to reduce the adverse effects induced by treatment. Combined colchicine therapy is gradually being embraced in clinical care, but the evidence remains insufficient.
METHODS
English databases were searched from the establishment to September 4, 2024. Eleven eligible Randomized controlled trials (RCTs) were included. The quality of the literature was assessed by the risk of bias tool in the Cochrane Handbook. Relative risk (RR) and Cohen's d (SMD) were used for categorical and continuous variables, respectively, at 95% confidence interval (CI), and Stata 17.0 software was used for statistical analysis. Sensitivity analyses were used to verify the stability of the analyzed results, and heterogeneity analyses were used to explore the sources of heterogeneity in the studies. Funnel plots and Egger's test were used to assess publication bias.
RESULTS
Eleven eligible RCTs were included in this study. Compared with conventional treatment, combined colchicine treatment improved patient's global assessment results (SMD = 1.24, 95% CI [0.01, 2.47], P = 0.05, I2 = 0]), stiffness (SMD = -0.81, 95% CI [-1.43, -0.19], P = 0.01, I2 = 63.91%]) and did not increase adverse effects (RR = 0.79, 95% CI [0.31, 1.27], P = 0.36, I2 = 0.00%). However, combined colchicine treatment did not improve visual analog scores (VAS) (SMD = -0.96, 95% CI [-2.85, 0.93], P = 0.13, I2 = 97.99%]), Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain (SMD = 0.01, 95% CI [-0.24, 0.27], P = 0.91, I2 = 0]), WOMAC function (SMD = -0.01, 95% CI [-0.36, 0.16], P = 0.44, I2 = 0]), Total WOMAC scale (SMD = -0.05, 95% CI [-0.33, 0.22], P = 0.70, I2 = 0]), physician 's global assessment (SMD = 0.36, 95% CI [-2.27, 3.00], P = 0.79, I2 = 97.04%]) and Modified Clinical Health Assessment Questionnaire (ModHAD) (SMD = -1.72, 95% CI [-4.90,1.45], P = 0.29, I2 = 99.11%]).
CONCLUSION
Compared with colchicine alone, combination therapy improves patients' quality of life without increasing the incidence of adverse events.
背景
关节炎严重影响人们的生活质量，临床上迫切需要提高药物疗效并减少治疗引起的不良反应。秋水仙碱联合疗法在临床护理中逐渐得到应用，但证据仍然不足。
方法
检索英文数据库自建库至2024年9月4日。纳入11项符合条件的随机对照试验（RCT）。采用Cochrane手册中的偏倚风险工具评估文献质量。分类变量和连续变量分别采用相对危险度（RR）和Cohen's d（标准化均数差，SMD），95%置信区间（CI），并使用Stata 17.0软件进行统计分析。采用敏感性分析验证分析结果的稳定性，采用异质性分析探索研究中的异质性来源。采用漏斗图和Egger检验评估发表偏倚。
结果
本研究纳入11项符合条件的RCT。与传统治疗相比，秋水仙碱联合治疗改善了患者的整体评估结果（SMD = 1.24，95%CI [0.01, 2.47]，P = 0.05，I² = 0）、僵硬程度（SMD = -0.81，95%CI [-1.43, -0.19]，P = 0.01，I² = 63.91%），且未增加不良反应（RR = 0.79，95%CI [0.31, 1.27]，P = 0.36，I² = 0.00%）。然而，秋水仙碱联合治疗未改善视觉模拟评分（VAS）（SMD = -0.96，95%CI [-2.85, 0.93]，P = 0.13，I² = 97.99%）、西安大略和麦克马斯特大学关节炎指数（WOMAC）疼痛评分（SMD = 0.01，95%CI [-0.24, 0.27]，P = 0.91，I² = 0）、WOMAC功能评分（SMD = -0.01，95%CI [-0.36, 0.16]，P = 0.44，I² = 0）、WOMAC总评分（SMD = -0.05，95%CI [-0.33, 0.22]，P = 0.70，I² = 0）、医生整体评估评分（SMD = 0.36，95%CI [-2.27, 3.00]，P = 0.79，I² = 97.04%）和改良临床健康评估问卷（ModHAD）评分（SMD = -1.72，95%CI [-4.90, 1.45]，P = 0.29，I² = 99.11%）。
结论
与单用秋水仙碱相比，联合治疗可改善患者生活质量且不增加不良事件发生率。
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