清热利湿法治疗急性痛风性关节炎临床疗效的Meta分析

摘要

目的：评价清热利湿法治疗急性痛风性关节炎疗效和安全性。方法：通过计算机检索中国知网（CNKI）、维普网（VIP）、万方数据库，以及PubMed外文数据库，查找国内外关于清热利湿法治疗急性痛风性关节炎的随机对照试验，检索日期自建库到2015年12月。纳入文献采用Jadad评分，运用Cochrane协作网提供的RevMan 5.3软件进行有效率、药物不良反应的Meta分析。结果：共纳入符合标准文献14篇，Jadad评分高质量文献3篇。Meta分析结果显示：①有效率比较，异质性检验（χ2=15.67， df =13，P =0.27>0.1，I2=17%<50%），数据具有同质性，采用固定效应模式进行Meta分析。合并效应量为2.44，95%CI =[1.68，3.43]，合并效应量的检验Z =4.81，P <0.00001，差异均有统计学意义。置信区间落在无效线右侧，表明清热利湿法治疗组效应量大于西药对照组。②漏斗图散点分布不对称，提示纳入文献有一定选择性偏倚。③不良反应比较，清热利湿法治疗组不良反应发生率明显低于西药对照组。结论：清热利湿法治疗痛风急性期具有较好临床疗效，且不良反应少。但目前研究存在一些试验设计问题，高质量文献较少，存在一定的选择性偏倚。%[ABSTRACT]Objective:To evaluate the efficacy and safety of clearing away heat and eliminating dampness in the treatment of acute gouty arthritis.Methods:Randomized controlled trials on the treatment of acute gouty arthritis by clearing away heat and eliminating dampness at home and abroad were searched through CNKI,VIP,Wanfang database and PubMed database(from the establishment of the database to December 2015). Jadad was used to score the included literature and Man Rev 5.3 software provided by Cochrane network was used to carry out a Meta analysis of effective and adverse drug reaction.Results:A total of 14 literatures were included in the analysis and three of them had high quality.Meta analysis results:①Efifciency comparison and the test for heterogeneity(χ2 = 15.67,df = 13,P = 0.27 > 0.1,I2 = 17%< 50%) showed that the data had homogeneity.Fixed effect model was used to carry out the Meta analysis.The combined effect was 2.44,95%CI =[1.68,3.43],and the test of combined effect was Z = 4.81 ,the difference being statistically significant (P< 0.000 01).The conifdence interval was on the right side of the invalid line,which showed that the effect of the treatment group treated by clearing away heat and eliminating dampness was greater than that of the control group treated with western medicine.②The distribution of the funnel plot was asymmetrical,which suggested that there was a certain selective bias of the literature.③As for the comparison of the adverse reactions,the incidence of adverse reaction of the treatment group was signiifcantly lower than that of the control group.Conclusion:Method of clearing away heat and eliminating dampness has a better clinical effect and less adverse reaction.But there are some experimental design problems at present,and there are only a few high quality literatures,so selective biases are inevitable.