中药治疗重症肌无力随机对照试验的Meta分析

目的：系统评价中药治疗重症肌无力的临床疗效。方法：计算机检索CNKI中国知网（总库）、维普数据库、PubMed、Cochrane图书馆，查找以中药治疗重症肌无力的随机对照试验。由两名评价者独立对纳入文献进行信息录入、质量评价。采用RevMan5.2软件进行Meta分析。结果：共纳入58个临床随机对照试验，包括4 773例患者。纳入中文文献质量普遍不高，高质量文献有4篇，其余为低质量文献。结果显示：与西药组治疗重症肌无力临床疗效相比，中药复方治疗无统计学意义RR=1.15，95%CI（0.94，1.41）]，中药复方联合西药治疗有统计学意义RR=1.10，95%CI（1.03，1.18）]，中成药联合西药治疗有统计学意义RR=1.17，95%CI（1.08，1.28）]。中药复方联合西药治疗重症肌无力不良反应（肌无力一过性加重、血糖增高、白细胞下降、血小板下降、胃肠反应）发生率低于单纯西药治疗组（P<0.05）。结论：现有有限证据表明，单用中药复方治疗重症肌无力临床疗效与西药组作用相似，但中药联合西药治疗重症肌无力较西药治疗更为有效，并能降低西药的副作用。并且中药组方中尤以黄芪应用为多。但上述结论尚需大样本高质量临床试验加以证实。

Chinese Herbs for Treatment of Myasthenia Gravis: A Meta-analysis of Randomized Control Trials

This study was aimed to assess the clinical efficacy of Chinese herbs for myasthenia gravis. Randomized controlled trials (RCTs) on Chinese medicine treatment of myasthenia gravis were systemically searched from the China National Knowledge Infrastructure (CNKI), Weipu Database, PubMed and Cochrane Library. The information was recorded and the methodological quality of the included trials was assessed by two reviewers independently. The RevMan 5.2 software was used in the meta-analysis. The results showed that 58 RCTs involving 4 773 patients were included. The quality of included Chinese literatures was generally not high. There were four high-quality literatures; and the rest were low-quality literature. The results of meta-analysis showed that compared with the effective rate of the western medical treatment group, there was no statistical difference between the Chinese medicine compound and the western medical treatment RR = 1.15, 95%CI (0.94, 1.41)]. There was statistical difference between the western medical treatment plus the Chinese medicine compound group and the western medical treatment RR = 1.10, 95%CI (1.03, 1.18)]. There was statistical difference between the western medical treatment plus the Chinese patent medicine group and the western medical treatment RR = 1.17, 95%CI (1.08, 1.28)]. Compared with the western medical treatment group, the incidence of adverse reaction in the Chinese medicine compound plus the western medical treatment group was decreased obviously (P < 0.05). It was concluded that the current limited evidence showed that only using Chinese medicine had the similar clinical efficacy in the treatment of myasthenia gravis as western medicine. However, Chinese herbs combined with western medicine in the treatment of myasthenia gravis had better effects compared to western medicine. It can also reduce the side effects of western medicine. Especially astragalus was the most widely used herb in the Chinese medicine group. However, large-sample and high-quality clinical trials were required for further evidence.