CAJ | 학술논문

背景：目前类风湿关节炎在治疗上选择甲氨蝶呤单独疗法还是三联疗法存在争议。 　　目的：系统评价甲氨蝶呤单独疗法与甲氨喋呤+羟氯喹+柳氮磺吡啶三联疗法比较治疗类风湿关节炎的有效性和安全性。 　　方法：计算机检索 Cochrane 图书馆、PubMed、EMBASE NRR (http：//www.updatesoftware.com/National)、CCT(http：//www.control ed-trails.com)和中国生物医学文献数据库(CBM)。手工检索(中文主要骨科杂志)。收集甲氨蝶呤单独疗法与甲氨喋呤+羟氯喹+柳氮磺吡啶三联疗法比较治疗类风湿关节炎的随机对照试验,并评价纳入研究的方法学质量。统计采用Cochrane协作网提供的Revman 5.0软件进行分析。 　　结果与结论：共纳入随机对照试验4篇，共297例患者，方法学质量均为B 级。Meta分析结果表明,甲氨蝶呤单独疗法与三联疗法比较，甲氨蝶呤单独疗法在血沉方面的改善要大于三联疗法[MD=7.0195%CI(2.82，11.19)，P=0.001]，三联疗法在关节改善情况方面优于单独疗法[OR=0.6295%(0.41，0.95)，P=0.03]，在不良反应上，两者差异无显著性意义。而ACR因文献未提供详细数据未能做Meta分析。与三联疗法治疗相比，甲氨蝶呤单独疗法更明显降低成人类风湿关节炎的血沉，但在关节功能改善方面三联疗法要优于甲氨蝶呤单独疗法。而在不良反应上，两组差异无显著性意义。因这次系统评价纳入的病例数较少，尚需更多设计严格的大样本随机对照研究来增加证据的强度。
배경：목전류풍습관절염재치료상선택갑안접령단독요법환시삼련요법존재쟁의。 　　목적：계통평개갑안접령단독요법여갑안첩령+간록규+류담광필정삼련요법비교치료류풍습관절염적유효성화안전성。 　　방법：계산궤검색 Cochrane 도서관、PubMed、EMBASE NRR (http：//www.updatesoftware.com/National)、CCT(http：//www.control ed-trails.com)화중국생물의학문헌수거고(CBM)。수공검색(중문주요골과잡지)。수집갑안접령단독요법여갑안첩령+간록규+류담광필정삼련요법비교치료류풍습관절염적수궤대조시험,병평개납입연구적방법학질량。통계채용Cochrane협작망제공적Revman 5.0연건진행분석。 　　결과여결론：공납입수궤대조시험4편，공297례환자，방법학질량균위B 급。Meta분석결과표명,갑안접령단독요법여삼련요법비교，갑안접령단독요법재혈침방면적개선요대우삼련요법[MD=7.0195%CI(2.82，11.19)，P=0.001]，삼련요법재관절개선정황방면우우단독요법[OR=0.6295%(0.41，0.95)，P=0.03]，재불량반응상，량자차이무현저성의의。이ACR인문헌미제공상세수거미능주Meta분석。여삼련요법치료상비，갑안접령단독요법경명현강저성인류풍습관절염적혈침，단재관절공능개선방면삼련요법요우우갑안접령단독요법。이재불량반응상，량조차이무현저성의의。인저차계통평개납입적병례수교소，상수경다설계엄격적대양본수궤대조연구래증가증거적강도。
BACKGROUND:At present, it is controversial to choose methotrexate therapy alone or triple therapy in the treatment of rheumatoid arthritis. OBJECTIVE:To systemical y evaluate the efficacy and safety of methotrexate therapy and methopterin+hydroxychloroquine+sulfasalazine triple therapy in the treatment of rheumatoid arthritis. METHODS:Computer retrieval was performed on the Cochrane library, PubMed, EMBASE NRR (http://www.updatesoftware.com/National), CCT (http://www.control ed-trails.com) and the Chinese biomedical literature database. Manual retrieval was performed on Chinese major orthopedic journals. Randomized control ed trials of methotrexate therapy alone and methopterin+hydroxychloroquine+sulfasalazine triple therapy treatment for rheumatoid arthritis were col ected. Methodological quality of the included studies was evaluated. The statistical software Revman 5.0 provided by the Cochrane col aboration was used. RESULTS AND CONCLUSION: A total of four literatures in a randomized control ed trial, a total of 297 cases were included;the methodological quality was al class B. Meta-analysis results showed that blood sedimentation improvements were larger in methotrexate therapy alone than in the triple therapy [mean difference=7.01, 95%confidence interval (CI) (2.82, 11.19), P=0.001). Improvements of joints were better in triple therapy than that in single therapy [OR=0.62, 95%CI (0.41, 0.95), P=0.03). There was no significant difference in adverse events. Meta analysis could not be done in ACR, because literature did not provide detailed data. Compared with the triple therapy treatment, methotrexate therapy alone obviously reduced the sedimentation of rheumatoid arthritis in adults, but in terms of joint function improvement, triple therapy was superior to methotrexate therapy alone. Moreover, on the adverse event, there was no significant difference between the two groups. Because this system evaluation included a less number of cases, it stil needs strict large-sample randomized control ed studies to increase the strength of the evidence.