中药治疗弥漫性毒性甲状腺肿随机对照试验临床疗效的系统评价

目的系统地评价中药治疗弥漫性毒性甲状腺肿(Graves)病的临床疗效及其安全性。方法两名研究者独立进行计算及检索并进行系统地整理,检索年限为自建库年至2018年11月。检索语种为中英文,中文数据库有中国学术文献总库(CNKI)、中国生物医学文献数据库(CBM)、万方数字化期刊库和维普中文科技期刊数据库(VIP)。英文数据库为The Cochrane Library数据库、Pub Med电子期刊数据库、Note Express数据库和Springer电子期刊数据库,运用Review Manager 5. 3软件对数据进行统计学管理和处理。结果本研究共纳入10篇RCT文献,合计658例Graves病患者。两组治疗前后综合疗效Meta分析结果显示:OR=5. 0,95%CI为(2. 42,10. 36),P <0. 00001,表明试验组的综合疗效优于对照组;两组治疗前后中医证候积分Meta分析结果显示:OR=-3. 36,95%CI(-5. 34,-1. 39),P=0. 0008,表明试验组在改善Graves病患者中医证候积分方面优于对照组;两组治疗前后FT3、FT4、TSH、TRAb、TPOAb和TGAb的Meta分析结果显示分别为P <0. 00001、P <0. 00001、P <0. 0001、P=0. 04、P=0. 34、P <0. 0001,表明试验组在改善FT3、FT4、TSH、TRAb和TGAb等指标的疗效优于对照组,在改善TPOAb这一指标方面与对照组无统计学差异。两组治疗前后心率Meta分析结果显示:MD=-1. 98,95%CI(-3. 81,-0. 15),P=0. 03 <0. 05,表明试验组在改善Graves病患者心率方面优于对照组;两组治疗前后体重Meta分析结果显示:P=0. 14> 0. 05,表明试验组在改善Graves病患者体重方面与对照组无统计学差异。结论单纯中药或中西医结合治疗Graves病的临床疗效优于单纯西药治疗,尤其在改善中医证候积分、FT3、FT4、TSH、TRAb、TGAb以及改善心率等方面具有明确的疗效,并且具有较高的安全性。

Clinical Efficacy of Traditional Chinese Medicine in Treatment of Graves Disease:A Meta Analysis

Objective To evaluate the clinical efficacy and safety of traditional Chinese medicine in the treatment of Graves disease.Methods The two researchers carried out the calculation and retrieval independently and carried out systematic sorting.The retrieval period was from the year of self-built database to November 2018.The Chinese database included the Chinese academic literature database(CNKI),the Chinese biomedical literature database(CBM),Wanfang digital periodical database and the Weipu Chinese science and technology periodical database(VIP).The English database included The Cochrane Library database,Pub Med electronic periodical database,Note Express database and Springer electronic periodical database.The data was managed and processed by Review Manager 5.3 software.Results Ten articles of RCT were included in this study.658 patients with Graves disease were included in this study.The curative effect of the experimental group was better than that of the control groupOR=5.0,95%CI(2.42,10.36),P<0.00001].The TCM syndrome integral of the experimental group was better than that of the control groupOR=-3.36,95%CI(-5.34,-1.39),P=0.0008].The levels of FT3,FT4,TSH,TRAb,TPOAb and TGAb of the experimental group were better than those of the control groupP<0.00001,P<0.00001,P<0.0001,P=0.04,P=0.34 and P<0.0001].The heart rate of the experimental group was better than that of the control groupMD=-1.98,95%CI(-3.81,-0.15),P=0.03<0.05].The weight of the experimental group was not better than that of the control groupP=0.14>0.05].Conclusion The clinical efficacy of traditional Chinese medicine or combination of traditional Chinese and western medicine in the treatment of Graves disease is better than that of western medicine alone,especially in improving TCM syndromes score,levels of FT3,FT4,TSH,TRAb and TGAb and heart rate,and has high safety.