来源：风湿病与关节炎,2018,7（11）:25-31.

桂枝芍药知母汤联合常规西药对类风湿关节炎疗效的Meta分析（循证研究）

董龙聪¹，邓路达¹，兰维娅¹，付盈悦¹，潘建翔¹，向开维²

　　【摘　要】目的：系统评价桂枝芍药知母汤联合西药治疗类风湿关节炎的临床疗效。方法：计算机检索PubMed、EMbase、The Cochrane Library、中国知网（CNKI）、中国生物医学文献数据库（CBM）、维普（VIP）、万方（WANFANG DATA）等数据库，检索时间为数据库建立至2018年4月，以桂枝芍药知母汤联合西药治疗类风湿关节炎的临床随机对照试验（RCT）为研究对象。由2位研究员独立筛选文献，提取文献资料及评估偏倚风险并采用RevMan 5.3软件对数据进行分析。结果：共纳入12篇RCT，包括1022例患者，其中试验组529例，对照组493例。Meta分析结果显示：桂枝芍药知母汤联合西药能提高疗效（RR = 1.24，95%CI = ［1.16，1.32］，P < 0.000 01），且桂枝芍药知母汤联合西药在关节压痛数（WMD = -3.24，95%CI = ［-5.10，-1.37］，P = 0.000 7）、关节肿胀数（WMD = -1.41，95%CI = ［-2.09，-0.74］，P < 0.000 1）、晨僵时间（WMD = -8.79，95%CI = ［-14.28，-3.30］，P = 0.002）、C-反应蛋白（WMD = -5.18，95%CI = ［-5.75，-4.62］，P < 0.000 1）、红细胞沉降率（WMD = -8.55，95%CI = ［-12.08，-5.61］，P < 0.000 01）、类风湿因子（WMD = -13.46，95%CI = ［-20.43，-6.48］，P = 0.000 2）等指标改善方面均优于常规西药组。纳入的研究有6篇提及不良反应。结论：桂枝芍药知母汤联合西药治疗类风湿关节炎可以提高临床疗效，但现有临床研究存在数量少、质量低等问题，需要更多高质量、大样本、多中心的临床随机双盲研究进一步验证。

　　【关键词】　关节炎，类风湿；桂枝芍药知母汤；西药；Meta分析

Meta-analysis on the Efficacy of Guizhi Shaoyao Zhimu Tang（桂枝芍药知母汤）Combined with Western Medicine in the Treatment of Rheumatoid Arthritis

DONG Long-cong,DENG Lu-da,LAN Wei-ya,FU Ying-yue,PAN Jian-xiang,

XIANG Kai-wei

　　【ABSTRACT】Objective:To systematically evaluate the clinical efficacy of Guizhi Shaoyao Zhimu Tang（桂枝芍药知母汤）combined with western medicine in the treatment of rheumatoid arthritis.Methods:The clinical randomized controlled trials（RCT）on the treatment of rheumatoid arthritis with Guizhi Shaoyao Zhimu Tang combining western medicine were retrieved by computer in the databases such as PubMed,EMbase,The Cochrane Library,CNKI,CBM,VIP,and WANFANG DATA from the establishment of the bases to April 2018.Two researchers independently screened the literature,extracted the literature,assessed the risk of bias,and analyzed the data using the software RevMan 5.3.Results:A total of twelve RCT were included,consisting of 1022 patients,among which 529 cases in the experimental group and 493 cases in the control group.Meta-analysis showed that Guizhi Shaoyao Zhimu Tang combining western medicine could improve curative effect（RR = 1.24,95%CI =［1.16,1.32］,P < 0.000 01）,and the combination was better than the conventional western medicine group in improving indexes such as joint tenderness（WMD = -3.24,95%CI =［-5.10,-1.37］,P = 0.000 7）,joint swelling（WMD = -1.41,95%CI =［-2.09,-0.74,P < 0.0001）,morning stiff time（WMD = -8.79,95%CI =［-14.28,-3.30］,P = 0.002）,C-reactive protein（WMD = -5.18,95% CI =［-5.75,-4.62］,P < 0.000 1）,erythrocyte sedimentation rate（WMD = -8.55,95%CI =［-12.08,-5.61］,P < 0.000 01）,and rheumatoid factors（WMD = -13.46,95%CI =［-20.43,-6.48］,P = 0.000 2）.Adverse reactions appeared in six articles.Conclusion:Guizhi Shaoyao Zhimu Tang combining western medicine can further improve the clinical efficacy of rheumatoid arthritis,but there is a small number of existing clinical studies with low quality and other problems,so the study needs further verifying with more multi-center clinical randomized double-blind studies with high quality and large sample.

　　【Keywords】 arthritis,rheumatoid;Guizhi Shaoyao Zhimu Tang（桂枝芍药知母汤）;western medicine;Meta-analysis