摘要
目的系统评价口服夏枯草制剂联合西医治疗Graves病的疗效及安全性,以期为Graves病的临床诊治提供循证医学证据。方法文章全面系统检索中文学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库(WanfangData)、维普中文期刊全文数据库(VIP)四大中文数据库和PubMed、Embase、CochraneLibrary三大英文数据库,检索时间均从建库至2022年08月。采用Cochrane系统偏倚风险评估工具对纳入研究进行质量评估,并用RevMan 5.4.1软件对结局指标进行Meta分析。结果最终纳入8项随机对照试验,共784例患者。试验组均为口服夏枯草制剂联合西医治疗,对照组均为西医治疗。Meta分析结果表明,口服夏枯草制剂联合西医治疗在甲状腺功能及自身抗体的改善、缩小甲状腺腺体等方面的临床治疗总有效率高于对照组(RR=1.13,95%CI[1.10,1.26],P<0.00001),并且能够显著改善甲状腺肿的临床症状(MD=-0.39,95%CI[-0.67,-0.11],P=0.006),降低血清FT3水平(MD=-1.76,95%CI[-3.10,-0.43],P=0.01)及血清FT4水平(MD=-3.89,95%CI[-6.79,-1.00],P=0.008),提高血清促甲状腺激素(TSH)水平(MD=0.45,95%CI[0.05,0.86],P=0.03),改善甲状腺肿大情况(MD=-0.39,95%CI[-0.67,-0.11],P=0.006),缩小甲状腺左叶前后径(MD=-0.31,95%CI[-0.57,-0.06],P=0.02)、左叶左右径(MD=-0.24,95%CI[-0.32,-0.16],P<0.00001)、右叶前后径(MD=-0.30,95%CI[-0.47,-0.13],P=0.0004)、右叶左右径(MD=-0.21,95%CI[-0.33,-0.10],P=0.0004)。结论夏枯草制剂联合西医治疗对比单用西医治疗Graves病在整体疗效、改善甲状腺肿的临床症状、甲状腺激素水平,缩小甲状腺腺体有明显的优势,且较安全,但仍需后续大样本、高质量文献的支持。
Objective To systematically evaluate the efficacy and safety of oral Prunella vulgaris preparation combined with western medicine in the treatment of Graves disease,in order to provide evidence-based basis for future clinical application.Methods The study comprehensively and systematically searched four Chinese databases:Chinese Academic Journal Full-text Database(CNKI),Chinese biomedical literature database(CBM),Wanfang Data,VIP and three English databases:PubMed,EM-BASE and Cochrane Library.The retrieval time was from the establishment of the database to August 2022.Cochrane systematic bias risk assessment tool was used to evaluate the quality of the included studies,and Revman 5.4.1 software was used to meta-analyze the outcome indicators.Results Eight randomized controlled trials with 784 patients were included.The experimental group was treated with oral Prunella vulgaris preparation combined with western medicine,and the control group was treated with western medicine.The results of meta-analysis showed that the total effective rate of oral Prunella vulgaris preparation combined with western medicine in improving thyroid function and autoantibody and reducing thyroid gland was higher than that in the con-trol group(RR=1.13,95%CI[1.10,1.26],P<0.00001),and could significantly improve the clinical symptoms of goiter(MD=-0.39,95%CI[-0.67,-0.11],P=0.006),Decreased serum FT3 level(MD=-1.76,95%CI[-3.10,-0.43],P=0.01)and serum FT4 level(MD=-3.89,95%CI[-6.79,-1.00],P=0.008),increased serum thyroid stimulating hor-mone(TSH)level(MD=0.45,95%CI[0.05,0.86],P=0.03),and improved goiter of thyroid gland(MD=-0.39,95%CI[-0.67,-0.11],P=0.006),The anterior posterior diameter of the left lobe(MD=-0.31,95%CI[-0.57,-0.06],P=0.02),the left and right meridians(MD=-0.24,95%CI[-0.32,-0.16],P<0.00001),the anterior posterior diameter of the right lobe(MD=-0.30,95%CI[-0.47,-0.13],P=0.0004)and the right and left meridians(MD=-0.21,95%CI[-0.33,-0.10],P=0.0004).Conclusion Prunella vulgaris preparation combined with western medicine has obvious advan-tages and safety in the overall curative effect,improving the clinical symptoms of goiter,improving the level of thyroid hormone and narrowing the thyroid gland.However,the conclusion still needs the support of follow-up large samples and high-quality literature.
作者
吴春丽
吴哲
徐慧蓉
孙小雯
李可建
WU Chuni;WU Zhe;XU Huirong;SUN Xiaowen;LI Kejian(Shandong University of Traditional Chinese Medicine,Jinan 250355,Shandong,China;Jinan Hospital of Integrated Traditional Chinese and Western Medicine,Jinan 271100,Shandong,China)
出处
《实用中医内科杂志》
2024年第3期3-7,I0001-I0003,共8页
Journal of Practical Traditional Chinese Internal Medicine
基金
国家自然科学基金面上项目(81673843)
山东省科学技术厅重点研发项目(2021CXGC10510)
山东省中医药管理局齐鲁医派中医学术流派传承项目(鲁卫函[2021]45号)。
关键词
夏枯草制剂
GRAVES病
随机对照试验
系统评价
prunella vulgaris preparation
graves disease
randomized controlled trial
systematic review
