本文選題：依托考昔 + 急性痛風(fēng)�。� 參考：《河北醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:非甾體抗炎藥(Nonsteroidal Anti-inflammatory Drugs,NSAIDs)的應(yīng)用已有上百年歷史,有數(shù)據(jù)證明,在中國(guó),NSAIDs銷售量?jī)H次于抗感染藥物,居第二位。NSAIDs通過抑制環(huán)氧化酶(Cyclooxygenase,COX)發(fā)揮作用,在急性痛風(fēng)性關(guān)節(jié)炎中的應(yīng)用較為廣泛,非選擇性NSAIDs療效確切,但不良反應(yīng)較多。隨著選擇性COX-2抑制劑在臨床中的應(yīng)用,國(guó)內(nèi)外不乏針對(duì)其與非選擇性NSAIDs療效和安全性的臨床隨機(jī)對(duì)照試驗(yàn)(Randomized Controlled Trial,RCT)。本文主要評(píng)價(jià)了依托考昔對(duì)比吲哚美辛、雙氯芬酸鈉、塞來昔布、美洛昔康治療急性痛風(fēng)性關(guān)節(jié)炎的療效與安全性。方法:運(yùn)用計(jì)算機(jī)檢索中國(guó)知網(wǎng)、萬方、維普、Cochrane圖書館、Em Base、OVID、Pub Med數(shù)據(jù)庫(kù)中依托考昔的臨床隨機(jī)對(duì)照試驗(yàn)。2名研究者獨(dú)立對(duì)文獻(xiàn)進(jìn)行閱讀篩選,評(píng)價(jià)質(zhì)量并提取數(shù)據(jù)。應(yīng)用Cochrane協(xié)作網(wǎng)提供的Rev Man 5.3進(jìn)行meta分析。結(jié)果:被納入研究的文獻(xiàn)總共有15篇。對(duì)于急性痛風(fēng)性關(guān)節(jié)炎的疼痛緩解,視覺模擬評(píng)分(Visual Analogue Scale,VAS)、5分Likert量表及總有效率三種疼痛評(píng)分方法均支持依托考昔優(yōu)于其它NSAIDs[SMD=-2.49,95%CI[-3.90,-1.08],P=0.0005;MD=-0.19,95%CI[-0.26,-0.11],P0.00001;OR=6.24,95%CI[1.75,22.27],P=0.005]。對(duì)于白細(xì)胞計(jì)數(shù)和C反應(yīng)蛋白的下降依托考昔優(yōu)于其它NSAIDs[SMD=-1.41,95%CI[-2.44,-0.39],P=0.007;MD=-0.91,95%[-1.74,-0.08],P=0.03]。依托考昔降尿酸作用優(yōu)于非選擇性NSAIDs,對(duì)比其它選擇性COX-2抑制劑,沒有顯著性差異[MD=24.64,95%CI[2.69,46.59],P=0.03;MD=-1.37,95%CI[-20.23,17.49],P=0.89]。在不良反應(yīng)上,依托考昔的總不良反應(yīng)發(fā)生率較低OR=0.43,95%CI[0.33,0.56],P0.00001。進(jìn)一步與非選擇性NSAIDs相比,依托考昔總不良反應(yīng)的發(fā)生較少OR=0.36,95%CI[0.26,0.50],P0.00001。而與其它選擇性COX-2抑制劑相比,無顯著性差異OR=0.65,95%CI[0.40,1.03],P=0.07。依托考昔有著更少的胃腸道副作用OR=0.33,95%CI[0.23,0.49],P0.00001。在心血管副作用上,依托考昔與其它NSAIDs無顯著性差異OR=0.77,95%CI[0.44,1.34],P=0.35。結(jié)論:依托考昔用于治療急性痛風(fēng)性關(guān)節(jié)炎有著良好的療效,并且安全性高,但仍需更多的隨機(jī)對(duì)照試驗(yàn)證實(shí)其對(duì)心血管副作用的影響。
[Abstract]:Objective: nonsteroidal Anti-inflammatory drugs (NSAIDs) have been used for more than 100 years. Data show that the sales volume of NSAIDs in China is second only to anti-infective drugs, and it is the second place of NSAIDs to play a role by inhibiting cyclooxygenase cyclooxygenase (COXs).It is widely used in acute gouty arthritis. Non-selective NSAIDs is effective, but there are more adverse reactions.With the application of selective COX-2 inhibitors in clinical practice, there is no shortage of randomized Controlled trials at home and abroad aimed at the efficacy and safety of NSAIDs and non-selective NSAIDs.This paper mainly evaluated the efficacy and safety of Ecoxim, diclofenac sodium, celecoxib and meloxicam in the treatment of acute gouty arthritis.Methods: a computer-based search was conducted in the Em Base OVIDPub Med database of China's Zhiwang, Wanfang and Wipline Cochrane Library. Two hundred and two researchers independently selected the literature, evaluated the quality and extracted the data, relying on the clinical randomized controlled trial of Cauxime.The meta analysis was carried out with Rev Man 5.3 provided by Cochrane cooperation network.Results: a total of 15 articles were included in the study.In adverse reactions, the incidence of total adverse reactions was lower than that of OR0.43 95 CI [0.33 鹵0.56] P 0.00001.Further more, compared with non-selective NSAIDs, the incidence of total adverse reactions was less than 0.36% CI [0.26 0.50] P 0.00001.Compared with other selective COX-2 inhibitors, there was no significant difference in CI (0.401.03).Ecoxim has fewer gastrointestinal side effects: 0.33 / 95 CI [0.23 / 0.49] P 0.00001.In cardiovascular side effects, there was no significant difference in cardiovascular side effects between the two groups. There was no significant difference between the two groups in the cardiovascular side effects. There was no significant difference between the two groups in the cardiovascular side effects. There was no significant difference between the two groups in the cardiovascular side effects.Conclusion: relying on coxa has good curative effect and high safety in treating acute gouty arthritis, but more randomized controlled trials are needed to prove its effect on cardiovascular side effects.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R589.7

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