雷鸣 姚斌 于晓倩 王方 李伟宁

中图分类号 R275 文献标志码 A 文章编號 1001-0408（2018）06-0828-05

DOI 10.6039/j.issn.1001-0408.2018.06.25

摘 要 目的：系统评价中药制剂外用治疗斑秃的疗效和安全性，并探讨其选方用药规律。方法：计算机检索PubMed、EMBase、Cochrane图书馆、中国生物医学文献数据库及中国期刊全文数据库等，纳入中药制剂外用（试验组）对比常规用药方案（对照组）治疗斑秃的随机对照试验（RCT），筛选文献、提取资料并采用改良的Jadad法量表评价纳入研究的质量。采用Rev Man 5.3统计软件对数据进行Meta分析，并对纳入方剂的药材进行频次统计和药味分析。结果：共纳入21项RCT，合计2 510例患者。Meta分析结果显示，试验组患者的总有效率显著高于对照组，差异有统计学意义[OR=4.14，95%CI（3.04，5.65），P<0.001]；两组患者不良反应发生率比较，差异无统计学意义[OR=1.66，95%CI（0.40，6.79），P=0.48]。纳入的21项RCT删除重复的方剂后共纳入方剂20首，共包含53味药材，各种药材的使用频次总和为138次。其中，使用频率较高的药味主要为红花、侧柏叶、丹参等，药材种类主要为补虚药、解表药、活血化瘀药等。结论：中药制剂外用治疗斑秃的疗效与安全性均较好，用药多以补虚、活血化瘀为主。

关键词 中药制剂外用；斑秃；Meta分析；用药规律

ABSTRACT OBJECTIVE： To systematically evaluate the therapeutic efficacy and safety of TCM external treatment for alopecia areata， and to investigate the regularity of prescription selection and medicine use. METHODS： Retrieved from PubMed， EMBase， Cochrane Library， CBM and CNKI， RCTs about TCM external treatment （trial group） vs. routine regimen （control group） in the treatment of alopecia areata were included. The qualities of included studies were evaluated with modified Jadad scale after literature screening and data extraction. Meta-analysis was conducted by using Rev Man 5.3 statistical software. Frequency statistics and ingredient analysis were conduced among included prescriptions. RESULTS： A total of 21 RCTs were included， involving 2 510 patients. Meta-analysis showed that total response rate of trial group was significantly higher than that of control group， with statistical significance [OR=4.14，95%CI（3.04，5.65），P<0.001]. There was no statistical difference in the incidence of ADR between 2 groups [OR=1.66， 95%CI（3.04，5.65），P=0.48]. A total of 20 prescriptions among included 21 RCTs were included after the repeated prescriptions were deleted. Above prescriptions were analyzed statistically； there were 53 ingredients in 20 prescriptions， and the sum of use frequency for those ingredients was 138. The ingredients with high use frequency were Carthamus tinctorius， Platycladus orientalis， Salvia miltiorrhiza； main types of medicines were restoring vital energy， relieving exterior disorder， invigorating blood circulation and eliminating stasis， etc. CONCLUSIONS： TCM external treatment shows good therapeutic efficacy and safety. Medicines are mainly used for restoring vital energy， invigorating blood circulation and eliminating stasis.

KEYWORDS TCM external treatment； Alopecia areata； Meta-analysis； Regularity of medicine use

斑秃是一种突然发生的局限性、自身免疫性的非瘢痕性脱发[1]。据统计，斑秃在全世界的发病率为0.1%～0.2%[2]。目前， 研究者多认为该病发病与自身免疫、遗传及环境有着密不可分的关系[1]，更有医家提出该病是一种“心身疾病”，社会、工作、生活模式的改变易加大患者心理压力而致精神情绪不佳，从而提高了斑秃的发病率；……