Efficacy and safety of external application of Traditional Chinese Medicine for the treatment of acute gouty arthritis: a systematic review and Meta-analysis
|
摘要
OBJECTIVE:To evaluate the clinical efficacy and safety of external application of Traditional Chinese Medicine(EATCM)on acute gouty arthritis(AGA).METHODS:Six electronic data bases were retrieved from their inception to march 2017.15 randomized controlled clinical trials(RCTs)were included.The quality of the literatures was assessed according to Cochrane review criteria by using RevMan5.3 software;and related data was counted using Stata14.0 software.RESULTS:There was no significant difference in C-reactiveprotein(CRP)between experimental intervention group and control group[(WMD= 1.093,95% CI(-2.514,4.701);P=0.553)].In terms of overall efficacy,the EATCM's treatment group was significantly superior to control group[(OR = 3.692; 95% CI(2.408,5.661); P<0.001)].The EATCM was better than western medicine treatments or other interventions in reducing the adverse reactions[(OR = 0.135; 95% CI(0.067,0.274); P<0.001)].All these funnel plots showed unlikelihood of publishing bias.But due to excessive heterogeneity,the statistical results of serum uric acid and visual analogue scale and CRP between the two groups became uncertain.CONCLUSION:The results indicate that EATCM may have greater overall efficacy with fewer adverse drug reactions,although the evidence is weak owing to the low methodological quality and the small number of the included trials.
OBJECTIVE:To evaluate the clinical efficacy and safety of external application of Traditional Chinese Medicine(EATCM)on acute gouty arthritis(AGA).METHODS:Six electronic data bases were retrieved from their inception to march 2017.15 randomized controlled clinical trials(RCTs)were included.The quality of the literatures was assessed according to Cochrane review criteria by using RevMan5.3 software;and related data was counted using Stata14.0 software.RESULTS:There was no significant difference in C-reactiveprotein(CRP)between experimental intervention group and control group[(WMD= 1.093,95% CI(-2.514,4.701);P=0.553)].In terms of overall efficacy,the EATCM's treatment group was significantly superior to control group[(OR = 3.692; 95% CI(2.408,5.661); P<0.001)].The EATCM was better than western medicine treatments or other interventions in reducing the adverse reactions[(OR = 0.135; 95% CI(0.067,0.274); P<0.001)].All these funnel plots showed unlikelihood of publishing bias.But due to excessive heterogeneity,the statistical results of serum uric acid and visual analogue scale and CRP between the two groups became uncertain.CONCLUSION:The results indicate that EATCM may have greater overall efficacy with fewer adverse drug reactions,although the evidence is weak owing to the low methodological quality and the small number of the included trials.
OBJECTIVE:To evaluate the clinical efficacy and safety of external application of Traditional Chinese Medicine(EATCM)on acute gouty arthritis(AGA).METHODS:Six electronic data bases were retrieved from their inception to march 2017.15 randomized controlled clinical trials(RCTs)were included.The quality of the literatures was assessed according to Cochrane review criteria by using RevMan5.3 software;and related data was counted using Stata14.0 software.RESULTS:There was no significant difference in C-reactiveprotein(CRP)between experimental intervention group and control group[(WMD= 1.093,95% CI(-2.514,4.701);P=0.553)].In terms of overall efficacy,the EATCM's treatment group was significantly superior to control group[(OR = 3.692; 95% CI(2.408,5.661); P<0.001)].The EATCM was better than western medicine treatments or other interventions in reducing the adverse reactions[(OR = 0.135; 95% CI(0.067,0.274); P<0.001)].All these funnel plots showed unlikelihood of publishing bias.But due to excessive heterogeneity,the statistical results of serum uric acid and visual analogue scale and CRP between the two groups became uncertain.CONCLUSION:The results indicate that EATCM may have greater overall efficacy with fewer adverse drug reactions,although the evidence is weak owing to the low methodological quality and the small number of the included trials.
引文
1 Smith HS,Bracken D,Smith JM.Gout:Current insights and future perspectives.J Pain 2011;12:1113-1129.
2 Richette P,Bardin T.Gout.Lancet 2009;375(9711):318-328.
3 Zhu Y,Pandya BJ,Choi HK.Prevalence of gout and hyperuricemia in the US general population:The National Health and Nutrition Examination Survey 2007-2008.Arthritis Rheum 2011;63(10):3136-3141.
4 Kuo CF,Grainge MJ,Zhang W,Doherty M.Global epidemiology of gout:prevalence,incidence and risk factors.Nat Rev Rheumatol 2015;11:649-662.
5 Kuang HT.Overview on the study of gout in Traditional Chinese Medicine.Hu nan Zhong Yi Za Zhi 2005;21(2):79-80.
6 Edwards NL,Sundy JS,Forsythe A,Blume S,Pan F,Becker MA.Work productivity loss due to flares in patients with chronic gout refractory to conventional therapy.JMed Econ 2011;14:10-15.
7 American College of Rheumatology.2012 American College of Rheumatology Guidelines for Management of Gout.Arthritis Care Res 2012;64(10):1447-1461.
8 Terkeltaub RA,Schumacher HR,Carter JD,et al.Rilonacept in the treatment of acute gouty arthritis:a randomized,controlled clinical trial using indomethacin as the active comparator.Arthritis Res Ther 2013;15(1):R25.
9 Wu SG.Rhymed Discourse for Topical Remedies.Beijing:China Traditional Chinese Medicine Publishing House,1995:1366-1368.
10 Wallace SL,Robinson H,Masi AT,Decker JL,Mc Carty DJ,Yu TF.Preliminary criteria for the classification of the acute arthritis of primary gout.Arthritis Rheum 1977;20(3):895-900.
11 Zhou CY,Sun SP,Fu XL.Chinese and Western Medicine diagnosis and treatment of rheumatism,Beijing:China Traditional Chinese Medicine Publishing House,1998:436.
12 Chen SL,Zou HJ.Rheumatology internal medicine.Beijing:People’s Medical Publishing House,2009:169.
13 State Administration of Traditional Chinese Medicine.Traditional Chinese Medicine diagnosis and treatment of standard.Nanjing:Nanjing University Press 1994:31-32.
14 Ministry of Health of the People's Republic of China.Chinese herbal medicine new medicine clinical research guiding principle.Beijing:Ministry of Health of the People's Republic of China,1995:15.
15 Savovi?J,Weeks L,Sterne JA,et al.Evaluation of the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials:focus groups,online survey,proposed recommendations and their implementation.Systematic Reviews 2014;3(1):3.
16 Chen Q.Clinical application of external application of Chinese medicine in the treatment of acute gouty arthritis.Zhong Guo Mei Rong Yi Xue 2010;19(5):235.
17 Du JH,Zhao XW,Wang HJ,Ma HJ.Clinical observation bone-setting powder in the treatment of acute gouty arthritis.Hebei Zhong Yi Za Zhi 2017;39(5):699-702.
18 Huang BX,Huang ML.San-huang powder and borneol Mirabilite in the treatment of acute gouty arthritis in 45cases.Fujian Zhong Yi Yao 2015;46(4):50-57.
19 Lin J.Clinical observation and nursing of Jia-wei golden ointment in the treatment of acute gouty arthritis.Hainan Yi Xue 2013;24(16):2483-2486.
20 Qiu S.Topical heat treatment of acute gouty arthritis 30cases.Shi Yong Zhong Yi Nei Ke Za Zhi 2012;26(6):59-61.
21 Qin XL,Xin XD,Qin J,et al.Clinical observation on treatment of acute gouty arthritis with Bai-yao ointment.Xin Zhong Yi Za Zhi 2010;42(11):60-62.
22 Sheng JH.Clinical effect of the spread of golden powder on the pain of acute gout arthritis.Chengdu:Chengdu Zhong Yi Yao Da Xue 2009;1-38.
23 Song CX.48 cases of acute gouty arthritis treated with the external application of Chinese Medicine.Shi Jie Zhong Xi Yi Jie He Za Zhi 2012;7(2):142-144.
24 Ta N,Li CS.Clinical observation of mongolian medicine detumescence Jiuweisan in the treatment of gouty arthritis.Ya Tai Chuan Tong Yi Yao Za Zhi 2017;13(12):15-17.
25 Wang AM,Wang Y,He L,Mi Y,Wan CF.Application of Zhongtongxiao curative effect observation on treatment of 50 cases of acute gouty arthritis.Zhejiang Zhong Yi Za Zhi 2016;51(2):125-126.
26 Xu JZ,Zheng C,Zhu JK,Wang E.Clinical observation on 60 cases of acute gouty arthritis treated by external application of"Black Medicine".Jiangsu Zhong Yi Yao Za Zhi 2010;42(8):32-33.
27 Yang BZS.Clinical observation of 32 cases of acute gout arthritis was treated by tibetan medicine gout pain eliminating paint.Zhong Guo Min Zu Min Jian Yi Yao Za Zhi2014;11(22):3-10.
28 Yu J,Gao ML,JI WF,Song LX,Xue SY,Xie S.Clinical observation on treatment of 30 cases of acute gouty arthritis by Qingbi powder.Xin Zhong Yi Za Zhi 2011;43(3):51-52.
29 Zhang LF,Zheng CH.Clinical observation on treatment of acute gouty arthritis by Ruyijinhuangsan acupoint application.Zhong Xi Yi Yan Jiu Za Zhi 2015;7(2):95-97.
30 Zhao Y,Ma BD,Chen YS.The effect of qing-bi powder on treatment of acute gout.Zhong Hua Zhong Yi Yao Xue Kan 2013;31(10):2275-2277.
31 Wu QZ,Zhou Q,LI L,Jiang Y.Effects of ice and nitric oxide on the swelling of the lower extremity fractures.Zhong Guo Zhong Yi Yao Xian Dai Yuan Cheng Jiao Yu Za Zhi 2017;15(2):128-129.
32 The Chinese Medical Association of Rheumatology.Diagnosis and treatment of primary gout guidelines.Zhong Hua Feng Shi Bing Xue Za Zhi 2011;15(6):410-413.
33 Ge JB,Xu YJ.Internal medicine M.Beijing:People's Medical Publishing House,2013:856.
34 Choi HK,Ford ES,Li C,Curhan G.Prevalence of the metabolic syndrome in patients with gout:the third national health and nutrition examination survey.Arthritis Rheum 2010;57(1):109-115.
35 Martinon F.Mechanisms of uric acid crystal-mediated autoinflammation.Immunol Rev 2010;233(1):218-232.
36 Mitroulis I,Kambas K,Chrysanthopoulou A,Skendros P,Apostolidou E.Neutrophil extracellular trap formation is associated with IL-1βand autophagy-related signaling in gout.PLOS One 2011;6(12):e29318.
37 Yuan L,Zhao Y.Experimental study of triple therapy for Damp-heat syndrome of acute senile gouty arthritis.Zhong Yi Lin Chuang Yan Jiu Za Zhi 2013;5(11):13-15.
2 Richette P,Bardin T.Gout.Lancet 2009;375(9711):318-328.
3 Zhu Y,Pandya BJ,Choi HK.Prevalence of gout and hyperuricemia in the US general population:The National Health and Nutrition Examination Survey 2007-2008.Arthritis Rheum 2011;63(10):3136-3141.
4 Kuo CF,Grainge MJ,Zhang W,Doherty M.Global epidemiology of gout:prevalence,incidence and risk factors.Nat Rev Rheumatol 2015;11:649-662.
5 Kuang HT.Overview on the study of gout in Traditional Chinese Medicine.Hu nan Zhong Yi Za Zhi 2005;21(2):79-80.
6 Edwards NL,Sundy JS,Forsythe A,Blume S,Pan F,Becker MA.Work productivity loss due to flares in patients with chronic gout refractory to conventional therapy.JMed Econ 2011;14:10-15.
7 American College of Rheumatology.2012 American College of Rheumatology Guidelines for Management of Gout.Arthritis Care Res 2012;64(10):1447-1461.
8 Terkeltaub RA,Schumacher HR,Carter JD,et al.Rilonacept in the treatment of acute gouty arthritis:a randomized,controlled clinical trial using indomethacin as the active comparator.Arthritis Res Ther 2013;15(1):R25.
9 Wu SG.Rhymed Discourse for Topical Remedies.Beijing:China Traditional Chinese Medicine Publishing House,1995:1366-1368.
10 Wallace SL,Robinson H,Masi AT,Decker JL,Mc Carty DJ,Yu TF.Preliminary criteria for the classification of the acute arthritis of primary gout.Arthritis Rheum 1977;20(3):895-900.
11 Zhou CY,Sun SP,Fu XL.Chinese and Western Medicine diagnosis and treatment of rheumatism,Beijing:China Traditional Chinese Medicine Publishing House,1998:436.
12 Chen SL,Zou HJ.Rheumatology internal medicine.Beijing:People’s Medical Publishing House,2009:169.
13 State Administration of Traditional Chinese Medicine.Traditional Chinese Medicine diagnosis and treatment of standard.Nanjing:Nanjing University Press 1994:31-32.
14 Ministry of Health of the People's Republic of China.Chinese herbal medicine new medicine clinical research guiding principle.Beijing:Ministry of Health of the People's Republic of China,1995:15.
15 Savovi?J,Weeks L,Sterne JA,et al.Evaluation of the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials:focus groups,online survey,proposed recommendations and their implementation.Systematic Reviews 2014;3(1):3.
16 Chen Q.Clinical application of external application of Chinese medicine in the treatment of acute gouty arthritis.Zhong Guo Mei Rong Yi Xue 2010;19(5):235.
17 Du JH,Zhao XW,Wang HJ,Ma HJ.Clinical observation bone-setting powder in the treatment of acute gouty arthritis.Hebei Zhong Yi Za Zhi 2017;39(5):699-702.
18 Huang BX,Huang ML.San-huang powder and borneol Mirabilite in the treatment of acute gouty arthritis in 45cases.Fujian Zhong Yi Yao 2015;46(4):50-57.
19 Lin J.Clinical observation and nursing of Jia-wei golden ointment in the treatment of acute gouty arthritis.Hainan Yi Xue 2013;24(16):2483-2486.
20 Qiu S.Topical heat treatment of acute gouty arthritis 30cases.Shi Yong Zhong Yi Nei Ke Za Zhi 2012;26(6):59-61.
21 Qin XL,Xin XD,Qin J,et al.Clinical observation on treatment of acute gouty arthritis with Bai-yao ointment.Xin Zhong Yi Za Zhi 2010;42(11):60-62.
22 Sheng JH.Clinical effect of the spread of golden powder on the pain of acute gout arthritis.Chengdu:Chengdu Zhong Yi Yao Da Xue 2009;1-38.
23 Song CX.48 cases of acute gouty arthritis treated with the external application of Chinese Medicine.Shi Jie Zhong Xi Yi Jie He Za Zhi 2012;7(2):142-144.
24 Ta N,Li CS.Clinical observation of mongolian medicine detumescence Jiuweisan in the treatment of gouty arthritis.Ya Tai Chuan Tong Yi Yao Za Zhi 2017;13(12):15-17.
25 Wang AM,Wang Y,He L,Mi Y,Wan CF.Application of Zhongtongxiao curative effect observation on treatment of 50 cases of acute gouty arthritis.Zhejiang Zhong Yi Za Zhi 2016;51(2):125-126.
26 Xu JZ,Zheng C,Zhu JK,Wang E.Clinical observation on 60 cases of acute gouty arthritis treated by external application of"Black Medicine".Jiangsu Zhong Yi Yao Za Zhi 2010;42(8):32-33.
27 Yang BZS.Clinical observation of 32 cases of acute gout arthritis was treated by tibetan medicine gout pain eliminating paint.Zhong Guo Min Zu Min Jian Yi Yao Za Zhi2014;11(22):3-10.
28 Yu J,Gao ML,JI WF,Song LX,Xue SY,Xie S.Clinical observation on treatment of 30 cases of acute gouty arthritis by Qingbi powder.Xin Zhong Yi Za Zhi 2011;43(3):51-52.
29 Zhang LF,Zheng CH.Clinical observation on treatment of acute gouty arthritis by Ruyijinhuangsan acupoint application.Zhong Xi Yi Yan Jiu Za Zhi 2015;7(2):95-97.
30 Zhao Y,Ma BD,Chen YS.The effect of qing-bi powder on treatment of acute gout.Zhong Hua Zhong Yi Yao Xue Kan 2013;31(10):2275-2277.
31 Wu QZ,Zhou Q,LI L,Jiang Y.Effects of ice and nitric oxide on the swelling of the lower extremity fractures.Zhong Guo Zhong Yi Yao Xian Dai Yuan Cheng Jiao Yu Za Zhi 2017;15(2):128-129.
32 The Chinese Medical Association of Rheumatology.Diagnosis and treatment of primary gout guidelines.Zhong Hua Feng Shi Bing Xue Za Zhi 2011;15(6):410-413.
33 Ge JB,Xu YJ.Internal medicine M.Beijing:People's Medical Publishing House,2013:856.
34 Choi HK,Ford ES,Li C,Curhan G.Prevalence of the metabolic syndrome in patients with gout:the third national health and nutrition examination survey.Arthritis Rheum 2010;57(1):109-115.
35 Martinon F.Mechanisms of uric acid crystal-mediated autoinflammation.Immunol Rev 2010;233(1):218-232.
36 Mitroulis I,Kambas K,Chrysanthopoulou A,Skendros P,Apostolidou E.Neutrophil extracellular trap formation is associated with IL-1βand autophagy-related signaling in gout.PLOS One 2011;6(12):e29318.
37 Yuan L,Zhao Y.Experimental study of triple therapy for Damp-heat syndrome of acute senile gouty arthritis.Zhong Yi Lin Chuang Yan Jiu Za Zhi 2013;5(11):13-15.