口服中药治疗皮肤瘙痒临床疗效的Meta分析

张宁 张玉鑫 张亚楠 殷晓辉 李冠汝 郑丰杰

摘要 目的：探讨口服中药联合常规治疗与常规治疗对皮肤瘙痒的临床疗效。方法：检索年国家知识基础设施数据库（CNKI）、中文科技期刊数据库（CCD）、中国学术期刊数据库（CSPD）、Ovid Medline、Embase 5个数据库，收集运用口服中药联合常规治疗与常规治疗干预皮肤瘙痒的随机对照试验，采用Revman 5.3进行数据分析。结果：最终纳入32项随机对照试验，2 750名受试者。Meta分析结果显示，与常规治疗比较，口服中药联合常规治疗可以显著降低瘙痒症状评分（SMD=-1.58，95%CI为-1.89～1.27，P<0.000 01），无论是长期治疗（SMD=-1.19，95%CI为-1.76～-0.62，P<0.000 01）还是短期治疗（SMD=-1.71，95%CI为-2.08～-1.34，P<0.000 01），皮肤病患者（SMD=-1.55，95%CI为-1.98～-1.22，P<0.000 01）还是其他疾病患者（SMD=-1.61，95%CI为-2.18～-1.04，P<0.000 01）。結论：口服中药能够有效降低瘙痒症状评分，缓解皮肤瘙痒症状。

关键词 皮肤瘙痒;口服中药;常规治疗;症状评分;长期疗效;短期疗效;系统评价;Meta分析

Systematic Review and Meta-Analysis of the Clinical Efficacy of Oral Chinese Medicine on Pruritus

ZHANG Ning1，ZHANG Yuxin1，ZHANG Yanan2，YIN Xiaohui1，LI Guanru3，ZHENG Fengjie1

（1 School of Traditional Chinese Medicine，Beijing University of Chinese Medicine，Beijing 100029，China; 2 School of Integrated Chinese and Western Medicine，Hebei University of Chinese Medicine，Shijiazhuang 050200，China; 3 Department of Dermatology，Shunyi Hospital，Beijing Hospital of Traditional Chinese Medicine，Beijing 101300，China）

Abstract Objective：To investigate the clinical effect of oral Chinese medicine combined with conventional treatment on itchy skin.Methods：A total of 5 databases including CNKI，WanFang，CCD，Medline （Ovid Medline） and Embase were searched for a randomized controlled trial of oral Chinese medicine combined with conventional treatment for skin itching.Systematic evaluation and meta-analysis were performed using Revman 5.3.Results：A total of 32 randomized controlled trials were included，involving 2，750 subjects.Meta-analysis showed that oral Chinese medicine combined with conventional treatment can significantly reduce the pruritus symptom score [SMD=-1.58，95% CI（-1.89 to -1.27），P<0.000 01].Compared with conventional treatment，oral Chinese medicine combined with conventional treatment can significantly reduce the score of pruritus symptoms [SMD=-1.58，95%CI（-1.89 to -1.27），P<0.000 01]，regardless of long-term treatment [SMD=-1.19，95%CI（-1.76 to -0.62），P<0.000 01] or short-term treatment [SMD=-1.71，95%CI（-2.08 to -1.34），P<0.000 01]，patients with skin diseases [SMD=-1.55，95%CI（-1.98 to -1.22），P<0.000 01] or patients with other diseases [SMD=-1.61，95%CI（-2.18 to -1.04），P<0.000 01].Conclusion：Oral Chinese medicine can more effectively reduce the itching symptom score and relieve the symptoms of itchy skin.

Keywords Skin itching; Oral Chinese medicine; Conventional treatment; Symptom score; Long-term efficacy; Short-term efficacy; Systematic evaluation; Meta-analysis

中图分类号：R242;R751文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.06.015

皮肤瘙痒是一种复杂的多因素皮肤症状[1]，不仅常见于各种急、慢性皮肤病，有时也是其他疾病的前兆症状[2]，如胆汁淤积、终末期肾病、神经和精神疾病等[3-5]。流行病学调查显示[6]，皮肤瘙痒在普通人群的发生率接近五分之一，在皮肤病患者中更高达54.4%。皮肤瘙痒不仅严重影响生命质量和社交活动，长期遭受皮肤瘙痒困扰更容易使人罹患抑郁、焦虑、失眠等精神障碍类疾病，甚至出现自杀倾向。

研究发现，皮肤瘙痒环境因素、生物因素、物理化学因素以及精神因素密切相关[7]。由于皮肤瘙痒病因的复杂性，使用指南推荐的抗组胺药、疼痛调节剂、阿片受体拮抗剂和抗抑郁药等并不能从根本上缓解大多数患者的皮肤瘙痒[8]。中医辨治皮肤瘙痒已有数千年历史，认为其多由脏腑功能失调、气血失常所引起，以风、湿、热、燥、虫为主要病因，多以祛风、利湿、清热、润燥、杀虫之法来治疗[9-11]。……