中药联合抗VEGF治疗湿性年龄相关性黄斑变性的疗效:系统评价与网状Meta分析

Efficacy of traditional Chinese medicine combined with anti-vascular endothelial growth factor in the treatment of wet age-related macular degeneration: A systematic review and network Meta-analysis

摘要:

目的：评价中药联合玻璃体腔内注射抗血管内皮生长因子(VEGF)与单纯抗VEGF药物治疗湿性年龄相关性黄斑变性(wAMD)的疗效。方法：检索中国知网、万方、维普、中国生物医学库CBM、Pubmed、Web of Science、Cochrane Library、Embase八大数据库，发表于建库以来至2022-04-20所有中英文文献。选取研究对象为wAMD患者，研究方法为比较中药联合抗VEGF药物与单纯抗VEGF药物治疗的临床随机对照实验研究。采用的结局指标为最佳矫正视力(BCVA)，黄斑中心凹厚度(CMT)。采用传统Meta和网状Meta分析对数据进行统计。结果：在617项确定的研究中，39项纳入分析，涉及28种口服中药，2757名参与者。在提高BCVA方面，中药联合抗VEGF药物治疗优于单纯抗VEGF药物治疗(MD=0.07， 95%CI： 0.05～0.09)。生蒲黄汤(SPD)在治疗后1、2mo最佳，血府逐瘀胶囊(XZC)在治疗后3mo最佳。在降低CMT方面，中药联合治疗效果更好(MD=-25.32μm， 95%CI： -30.06～-20.57)。当归明目汤(DMD)在治疗1mo后效果最好。补肾活血汤(BHD)在2mo时疗效最好。二陈二黄汤(EED)在3mo时疗效最好。结论：与单纯抗VEGF治疗相比，中药联合治疗可改善BCVA，降低CMT。然而，纳入的文献多为小样本、单中心、单盲随机对照试验，文献质量总体较低。

Abstract:

AIM:To evaluate the clinical efficacy of traditional Chinese medicine(TCM)combined with intravitreal injection of anti-vascular endothelial growth factor(VEGF)or anti-VEGF medicines alone in the treatment of wet age-related macular degeneration(wAMD).METHODS:A total of eight databases were searched for relevant literatures in English and Chinese, including Chinese National Knowledge Infrastructure(CNKI), Wanfang, CQVIP, SinoMed, PubMed, Web of Science, Cochrane Library, Embase. Taking patients with wAMD as research objects, the Chinese and English clinical randomized controlled trials(RCTs)published from the databases' inception to April 20, 2022, which compared TCM combined with anti-VEGF drugs with anti-VEGF drugs alone were selected. The outcome indicators were best corrected visual acuity(BCVA)and central macular thickness(CMT). Traditional Meta and network Meta analysis were used to examine the data.RESULTS:There were 39 eligible studies among the 617 retrieved articles, involving 28 oral administration of Chinese herbal medicines and 2 757 participants. For BCVA improvement, results of TCM combination therapy were more favorable than anti-VEGF alone(MD=0.07, 95%CI: 0.05～0.09). Sheng Puhuang Decoction(SPD)ranked highest in 1 and 2mo after treatment, and Xuefu Zhuyu Capsule(XZC)ranked highest in 3mo after treatment. In terms of reducing CMT, TCM combination therapy were better(MD=-25.32 μm, 95%CI: -30.06～-20.57). Danggui Mingmu Decoction(DMD)ranked the highest in 1mo after treatment. Bushen Huoxue Decoction(BHD)ranked the highest in 2mo. Erchen Erhuang Decoction(EED)ranked the highest in 3mo.CONCLUSIONS: Compared with anti-VEGF treatment alone, TCM combination therapy led to improved BCVA and reduced CMT. However, most of the included literature is small-sample, single-center, single-blind RCTs with an overall low quality.