| Background: Thyroid-associated Ophthalmopathy(TAO)is an organ-specific autoimmune disease with the highest incidence of orbital disease and severe clinical symptoms.It affects the quality of life,work and psychological health of patients seriously.Tripterygium wilfordii is the Chinese herbal anti-inflammatory immunomodulator,which is the first studied and used in China,known as the “Chinese herbal hormone”,It has the functions of promoting blood circulation and collateralization,dispelling wind and dehumidification,detumescence and pain,detoxification,anti-inflammatory and etc.Extract of tripterygium wilfordii is often used in the treatment of autoimmune diseases.There is a large number of clinical studies having found that tripterygium wilfordii can be used in the treatment of thyroid-associated ophthalmopathy.Objective: It is aimed to use meta-analysis to comprehensively and systematically evaluate 8 aspects,including total clinical eficacy,the degree of exophthalmus,quality of life score,CAS score,after treatment of thyroid related ophthalmopathy integral value,adverse reaction,worsening rate and recurrence rate.According to the different interventions,the total clinial efficacy and adverse reactions are divided into subgroup analysis,tripterygium wilfordii group vs Glucocorticoid group,tripterygium wilfordii combined with glucocorticoid group vs glucocorticoid,so as to provide evidence-based medical evidence for clinical drug use and experimental studies.Methods: Use computer to retrieve seven embase datebase: Full text database of wanfang academic journals(WF),Weipu Chinese science and technology periodical database(VIP),Chinese full-text periodical database(CNKI),the Chinese biomedical literature database(Sinomed),Pubmed and the Cochrane Library.The retrieval time is from the building time of the library to January 2020.The method of retrieval is the combination of the subject headings and keywords.Lastly,all the tripterygium wilfordii treatment of clinical controlled study of TAO has been screened.According to the inclusion and exclusion criteria,the two researchers independently screened the literature and extracted the data,evaluated the quality of the literature and cross-checked it.If they met the differences,the results would be handed over to the third researcher to cope with.The Revman 5.3 software is used for meta analysis of different outcome indicators in the included studies,and sensitivity analysis is conducted for literature with high heterogeneity.Results: A total of 25 references were included,with a total of1995 cases,959 cases in the control group and 1036 cases in the treatment group being into the research.The results of meta-analysis showed that there was heterogeneity among the studies on the three outcome indicators,including the total clinical efficacy,the degree of exophthalmus and adverse reaction.So,the random effect model was used.There was no heterogeneity among the other outcome indicators,and the fixed effect model was used.(1)the total clinical efficacy: The total clinical efficacy rate of tripterygium wilfordii group on TAO [RR=1.39,95%CI(1.14,1.69),P<0.001] was higher than that of the glucocorticoid group.The total clinical efficacy rate of tripterygium wilfordii combined with glucocorticoid group on TAO [RR=1.33,95%CI(1.25,1.41),P<0.00001] was higher than that of the glucocorticoid group.(2)Degree of exophthalmus: The degree of exophthalmus after treatment of TAO in the experimental group [SMD=-2.43,95%CI(-2.77,-2.09),P < 0.00001] was lower than that in the control group.There was no significant difference between the experimental group and the control group in the effective rate of degree of exophthalmus after treatment of thyroid-associated ophthalmopathy [RR=1.17,95%CI(0.98,1.41),P=0.08].(3)Quality of life score: The quality of life score of thyroid-associated ophthalmopathy in the experimental group [SMD=4.18,95%CI(3.64,4.72),P < 0.00001] was higher than that in the control group.(4)CAS score: The CAS score of the experimental group after treatment of thyroid-associated ophthalmopathy [SMD=0.08,95%CI(-0.60,0.75),P=0.83] showed no significant improvement compared with the control group.(5)The integral of thyroid-associated ophthalmopathy after treatment:The integral of thyroid-associated ophthalmopathy after treatment in the experimental group [SMD=-0.46,95%CI(-0.86,-0.05),P=0.003]was lower than that of the control group.(6)Adverse reactions: The adverse reactions of thyroid-associated ophthalmopathy treated with tripterygium wilfordii group [RR=0.60,95%CI(0.31,1.20),P=0.15] were not significantly different from those of the glucocorticoid group.The adverse reactions of tripterygium wilfordii combined with glucocorticoid group to treat thyroid-associated ophthalmopathy [RR=0.35,95%CI(0.22,0.55),P<0.00001] were lower than that of the glucocorticoid group.(7)Worsening rate: the worsening rate of thyroid-related eye disease in the experimental group [RR=0.26,95%CI(0.11,0.61),P=0.001]was lower than that in the control group.(8)Recurrence rate: the recurrence rate of thyroid-associated ophthalmopathy in the experimental group [RR=0.45,95%CI(0.27,0.74),P=0.002] was lower than that in the control group.Conclusion:The combination of tripterygium wilfordii in the treatment of thyroid-associated ophthalmopathy can improve the quality of life and the degree of exophthalmus,reduce the integral score,deterioration rate and recurrence rate of thyroid-related eye diseases.The CAS score is not significantly improved.There is no significant difference in the adverse reactions of tripterygium wilfordii alone compared with glucocorticoid in the treatment of TAO,but the clinical efficacy rate of tripterygium wilfordii is better.Tripterygium wilfordii combined with glucocorticoid group is better than glucocorticoid group,wether in the total clinical efficacy or adverse reactions.For the better clinical promotion of tripterygium wilfordii,more large sample,multi-center,randomized,double-blind and high-quality literature is needed for the aims of confirming tripterygeum wilfordii's efficacy and safety. |
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