天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (4): 320-326.doi: 10.11958/20192547

• 循证医学 • 上一篇    下一篇

雷公藤与阿维A治疗寻常型银屑病的系统评价 #br#

程毅，胡彩霞，崔瑜，王文氢
  

  1. 河北石家庄，河北医科大学第四医院皮肤科（邮编050000）
  • 收稿日期:2019-08-20 修回日期:2019-12-03 出版日期:2020-04-15 发布日期:2020-06-23
  • 作者简介:程毅（1984），女，硕士，主治医师，主要从事皮肤病相关研究与工作
  • 基金资助:
    河北省医学科学研究重点课题计划（20180509）

Systematic review and Meta-analysis of tripterygium wilfordii hook F and acitretin on the#br# randomized controlled trial for treatment of psoriasis vulgaris #br#

CHENG Yi, HU Cai-xia, CUI Yu, WANG Wen-qing #br#   

  1. Department of Dermatology, the Forth Hospital of Hebei Medical University, Shijiazhuang 050000, China
  • Received:2019-08-20 Revised:2019-12-03 Published:2020-04-15 Online:2020-06-23

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摘要： 目的 Meta 分析雷公藤与阿维 A 单独或联合治疗寻常型银屑病的疗效和安全性。方法 计算机检索
Pubmed、Cochrane、中国知网、万方医学网等数据库，收集雷公藤单独或联合阿维 A治疗寻常型银屑病的疗效和安全
性的随机对照试验。结局指标以银屑病皮损面积和严重性指数评分（PASI）表示，分别比较显效率（PASI评分改善
60%～89%）、基本痊愈率（PASI评分改善 90%～100%）、药物不良反应差异。对符合纳入标准的临床研究进行资料
提取和质量评价，采用Revman 5.3软件进行Meta分析。结果 共纳入13项研究，1 258例患者。雷公藤（n=284）与阿
维 A单药（n=273）相比，显效率（RR=1.08，95%CI：0.79～1.47，P=0.65）和基本痊愈率（RR=1.22，95%CI：0.67～2.22，P=
0.52）差异均无统计学意义。雷公藤联合阿维 A（n=368）与阿维 A 单药（n=365）相比，联合组显效率（RR=1.48，95%
CI：1.33～1.64，P＜0.01）和基本痊愈率（RR=1.44，95%CI：1.19～1.75，P＜0.01）均优于阿维 A单药组。联合组与阿维
A单药比较，胃肠不适（RR=0.54，95%CI：0.33～0.91，P＜0.05）、肝功能异常（RR=0.37，95%CI：0.18～0.78，P＜0.05）均减少，皮肤黏膜干燥（RR=0.66，95%CI：0.34～1.27，P=0.21）、血脂升高（RR=0.59，95%CI：0.31～1.11，P=0.10）差异无统计学意义。结论 雷公藤可有效治疗寻常型银屑病，雷公藤联合阿维A治疗寻常型银屑病效果优于阿维A单药。

关键词: 银屑病, 阿维A, 雷公藤, Meta分析

Abstract: Objective To analyze the efficacy and safety of tripterygium wilfordii hook F (TwHF) alone or combination
with acitretin in the treatment of psoriasis vulgaris, and provide evidence-based reference for clinical treatment. Methods
Pubmed, Cochrane, CNKI and Wanfang database were searched up to December 2018. Data of the randomized controlled
trial (RCT) of TwHF alone or in combination with acitretin for psoriasis vulgaris were collected. The primary end-point was
the proportions of patients achieved 60% to 89%, and 90% to 100% improvement in psoriasis area and severity index (PASI) respectively, which were considered as effective rate and cure rate. Adverse drug reactions were analyzed. A systematic review and meta-analysis were conducted for extracted data and quality evaluation by Rev Man 5.3 software. Results A total of 1 258 patients from 13 clinical trials were included in this study. There were no statistically significant differences in effective rate (RR=1.08，95%CI：0.79-1.47，P=0.65) and cure rate (RR=1.22，95%CI：0.67-2.22，P=0.52) between TwHF group (n=284) and acitretin group (n=273). The effective rate (RR=1.48, 95%CI：1.33-1.64, P＜0.01) and cure rate (RR=1.44, 95%CI：1.19-1.75, P＜0.01) were better in TwHF and acitretin combination group (n=368) than those of acitretin group (n=365). Compared with acitretin group, the incidence of gastrointestinal reactions (RR=0.54, 95%CI：0.33-0.91, P＜0.05) and abnormal liver function (RR=0.37, 95%CI：0.18-0.78, P＜0.05) were decreased in the combined group. There were no significant differences in dry skin or mucosa (RR=0.66, 95%CI：0.34-1.27, P=0.21) and elevated blood lipid (RR=0.59, 95%CI：0.31-1.11, P=0.10). Conclusion TwHF can effectively treat psoriasis vulgaris. TwHF combined with acitretin is superior to acitretin monotherapy in the treatment of psoriasis vulgaris.

Key words: psoriasis, Acitretin, Tripterygium wilfordii, Meta-analysis

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