主 办:北 京 中 医 药 大 学
ISSN 2095-6606 CN 10-1157/R

现代中医临床 ›› 2020, Vol. 27 ›› Issue (5): 39-48.doi: 10.3969/j.issn.2095-6606.2020.05.008

• 文献研究 • 上一篇    下一篇

中医药治疗年龄相关性黄斑变性的疗效和安全性系统综述及Meta分析*

余聪1, 吴烈2, 胡佩2, 张婷婷2, 张国亮2#   

  1. 1 重庆市急救医疗中心 重庆市第四人民医院 重庆 400014;
    2 中国中医科学院广安门医院
  • 收稿日期:2019-11-13 出版日期:2020-09-30 发布日期:2020-09-30
  • 通讯作者: # 张国亮,男,硕士,副主任医师,E-mail:darw8@163.com
  • 作者简介:余聪,男,硕士,住院医师
  • 基金资助:
    * 国家自然科学基金项目(No.81574030)

Traditional Chinese medicine for age-related macular degeneration: A systematic review of its efficacy and safety and meta-analysis*

Yu Cong1, Wu Lie2, Hu Pei2, Zhang Tingting2, Zhang Guoliang2#   

  1. 1 Chongqing Emergency Medical Center, the Fourth People’s Hospital of Chongqing, Chongqing 400014;
    2 Guang’anmen Hospital, China academy of Chinese medical sciences
  • Received:2019-11-13 Online:2020-09-30 Published:2020-09-30

摘要: 目的 评价中医药治疗年龄相关性黄斑变性的有效性和安全性。方法 计算机检索电子数据库CENTRAL、EMBASE、PubMed、中国知网、维普中文科技期刊全文数据库、万方数据资源系统,收集国内外公开发表的有关中医药治疗年龄相关性黄斑变性的临床随机对照试验,检索时限为1990年1月—2018年12月。两人独立按照纳排标准筛选文献、提取资料并核对结果,采用risk of bias工具进行方法学质量评估,运用RevMan5.3进行Meta分析。结果 共纳入25篇文献,合计1 885例年龄相关性黄斑变性(AMD)患者。Meta分析结果显示:在视力方面,中药组比西药组有略有优势,MD及95%CI为0.05(0.01,0.10),中药联合西药组优于西药组,MD及95%CI为0.12(0.08,0.16);在临床有效率方面,眼数统计组结果提示尚无足够证据表明中药组比西药组的临床疗效更好,中药联合西药组优于西药组,RR及95%CI为1.37(1.11,1.69),人数统计组显示中药组优于西药组,RR及95%CI为1.69(1.35,2.12),中药联合西药组优于西药组,RR及95%CI为2.17(1.41,3.33);黄斑中心凹厚度方面,中药联合西药组优于西药组,RR及95%CI为-28.98(-44.00,-13.96);生存质量方面,中医药可以提高AMD患者生存质量,但由于报道文献较少,可信度不高;复发率方面,由于报道文献较少,对复发率难以估计;安全性方面,对已报道数据分析,中药组、中药联合西药组、西药组在治疗年龄相关性黄斑变性安全性方面无明显差异,均较为安全。结论 中医药治疗AMD在提升视力、降低黄斑中心凹厚度方面具有一定疗效;在临床有效率方面尚无足够证据表明中医药治疗较西药治疗更优;在生存质量和复发率方面,由于报道文献较少,难以进行有效评价;中医药治疗AMD较为安全;中医药联合西药治疗AMD可能有协同增效的作用。

关键词: Meta分析, 年龄相关性黄斑变性, 中医药

Abstract: Objective To assess the effectiveness and safety of TCM in the treatment of age-related macular degeneration. Methods We searched CENTRAL, EMBASE, PubMed, CNKI, VIP, WANFANG DATA., between January 1990 to December 2018 to identify randomized clinical trials. Two researchers independently screened literature, extracted data and checked the results. We used risk of bias to evaluate methodological quality and used RevMan 5.3 for meta-analysis. Results We included 25 trials with a total of 1885 participants.In visual acuity, Chinese medicine group had slight advantage over Western medicine group (MD 0.05, 95%CI 0.01 to 0.10), the TCM in combination with Western medicine group was superior to Western medicine group (MD 0.12, 95%CI 0.08 to 0.16). In terms of counting by number of eye, there had not been adequate evidence to show that the clinical efficiency was better in Chinese medicine group than in Western medicine group. In terms of counting by number of people, the TCM group and the combination of the TCM and Western medicine group were superior to the Western medicine group in clinical efficiency (RR 1.69, 95%CI 1.35 to 2.12 and RR 2.17, 95%CI 1.41 to 3.33). The TCM in combination with Western medicine group decreased the CMT more than the Western medicine group (MD-28.98, 95%CI-44.00 to -13.96). TCM improved the quality of life in AMD patients, but due to the lack of literature reports, credibility was not satisfied. The recurrence rate was difficult to estimate because of lacking of reported literature. According to the reported data, there was no significant difference in the safety of treatment of age-related macular degeneration among the TCM group, the TCM in combination with Western medicine group and the Western medicine group, which were equally safe. Conclusions We found it had positive effects in improving visual acuity and reducing the CMT of the TCM treatment for AMD. There is less evidence to support the TCM is a better choice than Western ones in ameliorating clinical efficiency. In terms of quality of life and recurrence rate, it is difficult to evaluate the results effectively due to the lack of reported literature. TCM is relatively safe in the treatment of AMD. TCM combined with Western medicine may have synergistic effect in the treatment of AMD.

Key words: traditional Chinese medicine, meta analysis, age-related macular degeneration

中图分类号: 

  • R276.7