运用网状Meta分析对不同中成药联合重组人干扰素 α-2b(以下简称"干扰素")治疗宫颈人乳头瘤病毒(human papillomavirus，HPV)感染的疗效和安全性进行评价。计算机检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、Cochrane Library、EMbase、Web of Science数据库，搜索建库至2024年5月8日收录的随机对照试验(randomized controlled trial，RCT)。采用改良Jadad量表和Cochrane风险偏倚工具对纳入文献进行质量评价，采用RevMan 5。4、R 4。3。3、Stata 17软件进行数据分析。最终纳入105篇RCTs，样本量12732例，涉及保妇康栓、复方沙棘籽油栓、黄芪生脉饮、康妇凝胶、抗妇炎胶囊、苦参凝胶、蒲苓盆炎康颗粒7种中成药。网状Meta分析显示，①提高HPV转阴率方面，累计概率排名曲线下面积(surface under the cumulative ranking curve，SUCRA)排序第1的干预措施为蒲苓盆炎康颗粒+干扰素;②缩短阴道排液时间方面，SUCRA排序第1的干预措施为复方沙棘籽油栓+干扰素;③降低血清超敏C反应蛋白(hyper-sensitive C-reactive protein，hs-CRP)水平方面，SUCRA排序第1的干预措施为保妇康栓+干扰素;④提高血清CD+4 T细胞水平方面，SUCRA排序第1的干预措施为保妇康栓+干扰素;⑤提高血清CD+8 T细胞水平方面，SUCRA排序第1的干预措施为抗妇炎胶囊+干扰素;⑥改善血清CD+4/CD+8方面，SUCRA排序第1的干预措施为复方沙棘籽油栓+干扰素;⑦降低血清肿瘤坏死因子-α(tumor necrosis factor-α，TNF-α)、白细胞介素-6(interleukin-6，IL-6)、治疗后6个月复发率、不良事件发生率方面，各干预措施两两比较差异无统计学意义。聚类分析显示，蒲苓盆炎康颗粒+干扰素、保妇康栓+干扰素、康妇凝胶+干扰素、黄芪生脉饮+干扰素可同时改善HPV转阴率和不良事件发生率。结果表明，中成药联合干扰素治疗宫颈HPV感染能够提高转阴率，缩短阴道排液时间，降低hs-CRP水平，提高T淋巴细胞亚群水平，疗效可靠。受纳入文献样本量和质量限制，该结论有待更多大样本、高质量的RCT加以验证。
Network Meta-analysis of Chinese patent medicines combined with recombinant human interferon α-2b in treatment of cervical human papillomavirus infections
The study employed network Meta-analysis to evaluate the efficacy and safety of Chinese patent medicines combined with recombinant human interferon α-2b (interferon) in the treatment of cervical human papillomavirus (HPV) infections.The relevant randomized controlled trial (RCT) published from inception to May 8,2024 were retrieved from CNKI,Wanfang,VIP,SinoMed,PubMed,Cochrane Library,EMbase,and Web of Science.The modified Jadad scale and the Cochrane risk of bias tool were used to evaluate the quality of the included studies,and RevMan 5.4,R 4.3.3,and Stata 17 were used for data analysis.A total of 105 RCTs were included,involving 12732 participants and 7 Chinese patent medicines:Baofukang Suppository,Compound Seabuckthorn Seed Oil Suppository,Huangqi Shengmai Decoction,Kangfu Gel,Kangfuyan Capsules,Kushen Gel,and Puling Penyankang Granules.Network Meta-analysis yielded the following results:①For improving the negative conversion rate of HPV,SUCRA top-ranked intervention was Puling Penyankang Granules+interferon.② For shortening vaginal discharge time,SUCRA top-ranked intervention was Compound Seabuckthorn Seed Oil Suppository+interferon.③ For reducing the serum level of hypersensitive C-reactive protein (hs-CRP),SUCRA top-ranked intervention was Baofukang Suppository+interferon.④ For elevating the serum level of CD+4 T cells,SUCRA top-ranked intervention was Baofukang Suppository+interferon.⑤ For elevating the serum level of CD+8 T cells,SUCRA top-ranked intervention was Kangfuyan Capsules+interferon.⑥ For improving the CD+4/CD+8 ratio,SUCRA top-ranked intervention was Compound Seabuckthorn Seed Oil Suppository+interferon.⑦In terms of reducing serum tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),recurrence rate at 6 months after treatment,and incidence of adverse events,there were no significant differences between the interventions when compared pairwise.The cluster analysis revealed that Puling Penyankang Granules+interferon,Baofukang Suppository+interferon,Kangfu Gel+interferon,and Huangqi Shengmai Decoction+interferon simultaneously improved the negative conversion rate of HPV and reduced the incidence of adverse events.The findings suggested that Chinese patent medicines combined with interferon were effective in treating cervical HPV infection by enhancing the negative conversion rate,shortening the vaginal discharge time,and improving the levels of hs-CRP and T lymphocyte subsets.However,due to the limitations of sample size and quality of the included studies,these conclusions require further validation by studies with larger sample sizes and higher quality.
Chinese patent medicinerecombinant human interferon α-2bcervical human papillomavirus (HPV) infectionnetwork Meta-analysis
NETL
NSTL
万方数据
