摘要
目的:系统评价中西医结合疗法治疗神经系统自身免疫病的临床疗效。方法:全面检索中国期刊全文数据库(CNKI)、中国生物医学文献服务系统、万方医药期刊数据库、维普中文科技期刊全文数据库(VIP)、Pubmed、Cochrane图书馆等数据库,收集中西医结合治疗神经系统自身免疫病的随机对照试验,时间区间为2000年1月1日至2017年12月31日。神经系统自身免疫病主要发生在中枢神经以及周围神经,故本研究对中枢神经系统的多发性硬化,以及周围神经系统的格林-巴利综合征进行Meta分析。对纳入的文献进行偏倚风险和质量评估,并对中西医结合疗法治疗多发性硬化的Kurtzke扩展残疾状态量表(Kurtzke Extended Disability Status Scale,EDSS)、有效率、临床症状评分、神经功能体征评分、复发次数、不良反应发生率以及中西医结合疗法治疗格林-巴利综合征的有效率、Hughes评分进行Meta分析。结果:多发性硬化最终纳入16个随机对照试验,共800例。Meta分析结果显示,10项研究观察EDSS评分,9项研究可提取有效数据,MD值为-1. 07,95%CI为-1. 79,-0. 36,差异有统计学意义(P <0. 05); 10项研究观察有效率,OR为5. 91,95%CI为3. 51,9. 94,差异有统计学意义(P <0. 05); 4项研究进行临床症状评分,MD值为0. 30,95%CI为-3. 71,4. 31,差异无统计学意义(P=0. 88> 0. 05); 3项研究进行神经功能体征评分,MD值为-2. 11,95%CI为-6. 86,2. 64,差异无统计学意义(P=0. 38> 0. 05); 3项研究观察复发次数,MD值为-0. 41,95%CI为-0. 56,-0. 26,差异有统计学意义(P <0. 05); 4项研究观察不良反应的发生率,3项研究可提取有效数据,OR值为0. 20,95%CI为0. 03,1. 42,差异无统计学意义(P>0. 05)。格林-巴利综合征最终纳入9个随机对照临床试验,共599例研究对象。纳入的9篇文献中,有9项观察了有效率,观察组与对照组比较,OR值为3. 38,95%CI为1. 87,6. 14,差异有统计学意义(P <0. 05); 3项研究观察了Hughes评分,MD值为-0. 41,95%CI为-0. 75,-0. 07,差异有统计学意义(P <0. 05)。结论:中西医结合疗法治疗多发性硬化相较于单纯西药治疗,提高了其有效率,减少了复发次数以及改善了神经功能缺损;于格林-巴利综合征而言,同样在有效率方面具有明显的优势,同时也改善了其肢体功能情况,进而说明中西医结合治疗神经系统自身免疫病有显著的临床疗效。
Objective To evaluate the effects of integrated Chinese and western medicine in the treatment of neurological autoimmune diseases. Methods： The literature was comprehensively searched in China National Knowledge Infrastructure （CNKI）,Chinese Biomedical Literature Database （CBM）,Wan Fang Database,Chinese VIP database,PubMed,Cochrane Library,etc.to collect the randomized controlled trials about integrated Chinese and western medicine in the treatment of neurological autoimmune diseases.The time frame was range from January 1,2000 to December 31,2017.The neurological autoimmune diseases mainly occur in the central nervous system and peripheral nerves.Therefore,multiple sclerosis was chosen as the representative of the central nervous system,and Guillain-Barre syndrome was chosen as the representative of the peripheral nervous system.The bias risk and quality of the literature were evaluated.EDSS score （Extended Disability Status Scale）,effective rate,clinical symptom score,neurological functional sign score,recurrence frequency,incidence rate of adverse reactions were chosen as the markers of outcome variables of multiple sclerosis,and the effective rate and Hughes score were chosen as the markers of outcome variables of Guillain-Barre syndrome. Results： For multiple sclerosis,a total of 16 randomized controlled trials consisted of 800 cases were included.The results of meta-analysis showed that the data could be extracted from 9 out of 10 studies in which the EDSS score was observed.The data were as follows.MD and 95%CI were-1.07 （-1.79,-0.36）, P 〈0.05,which had difference in statistical analysis.With the effective rate observed in 10 studies,OR and 95%CI were 5.91 （3.51,9.94）, P 〈0.001,which had significant difference in statistical analysis.With the clinical symptom score observed in 4 studies,MD and 95%CI were 0.30,（-3.71,4.31）, P =0.88〉0.05,which had no significant difference in statistical analysis.With the neurological functional sign score observed in 3 studies,MD and 95%CI were-2.11,（-6.86,2.64）, P =0.38〉0.05,which had no significant difference in statistical analysis.With the recurrence frequency observed in 3 studies,MD and 95%CI were-0.41,（-0.56,-0.26）, P 〈0.001,which had significant difference in statistical analysis.With the incidence rate of adverse reactions observed in 4 studies,the data could be extracted from 3 ones,OR and 95%CI were 0.20,（0.03,1.42）, P 〉0.05,which had no significant difference in statistical analysis.For Guillain-Barre syndrome,9 randomized controlled clinical trials consisted of 599 cases were eventually included.With effective rate reported in 9 studies,the comparison between the experimental group and the control group showed that the value of OR was 3.38,and the 95% CI was （1.87,6.14）, P 〈0.001,which had significant difference in statistical analysis.With Hughes score observed in 3 studies,MD and 95%CI were-0.41（-0.75,-0.07）, P =0.02〈0.05,which had difference in statistical analysis. Conclusion： Integrated Chinese and western medicine in the treatment of multiple sclerosis is able to improve its efficiency,reduce the recurrence frequency and improve nerve defect compared with the western medicine treatment only.In the case of Guillain-Barre syndrome,this treatment not only has obvious efficiency,but also improves the physical function of the limbs.It further demonstrates that integrated Chinese and western medicine has significant clinical effects in the treatment of neurological autoimmune diseases.
作者
彭小燕
马金昀
程晓东
Peng Xiaoyan;Ma Jinyun;Cheng Xiaodong(Institute of Clinical Immunology,Yueyang Hospital of Integrated Traditional Chinese and Western Medicineof Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)
出处
《世界中医药》
CAS
2018年第10期2637-2646,共10页
World Chinese Medicine
基金
国家自然科学基金面上项目(81673669)
国家自然科学基金青年项目(81703782)
上海市中医药新兴交叉学科"中医临床免疫学"建设项目(30304113598)
上海中医药大学中医学高峰学科建设项目(30304114323)
关键词
多发性硬化
格林-巴利综合征
中西医结合
随机对照试验
中药
针灸
META分析
Multiple sclerosis
Guillain-Barre syndrome
Integrated Chinese and western medicine
Randomized controlled trial
Traditional Chinese medicine
Acupuncture
Meta-analysis
