WONCA研究论文摘要汇编——对乙酰氨基酚治疗脊椎疼痛和骨关节炎的疗效和安全性:对随机安慰剂对照试验的系统综述和荟萃分析

发布时间：2018-06-06 16:33

本文选题：WONCA + 系统综述　；参考：《中国全科医学》2015年15期

【摘要】：目的探讨对乙酰氨基酚(扑热息痛)治疗脊椎疼痛和骨关节炎(髋关节、膝关节)的有效性和安全性。设计系统综述和荟萃分析。数据来源Medline、荷兰医学文摘数据库(EMBase)、AMED、CINAHL、Web of Science、LILACS、国际药学文摘、Cochrane对照试验中心注册库,时间自建库至2014年12月。研究的纳入标准研究须为随机对照试验,比较扑热息痛和安慰剂治疗脊椎疼痛(颈痛或下腰痛)和骨关节炎(髋关节、膝关节)的疗效和安全性。数据的提取由2名独立的研究人员分别提取关于疼痛、失能和生活质量的数据。次要结果指标包括:不良反应、患者依从性和急救药物的使用。疼痛和失能评分转换为0(没有疼痛或失能)到100(疼痛加重和失能)的数值。采用随机效应模型计算加权均数差(WMD)或风险比(HR)以及95%可信区间(95%CI)。应用Cochrane协作工具对偏倚风险进行评估,采用GRADE方法对证据的质量进行评估,并对结论进行总结。结果共纳入12篇报道(13项随机试验)。对于下腰痛患者,扑热息痛在短期内减少疼痛强度〔WMD=-0.5,95%CI(-2.9,1.9)〕、失能〔WMD=0.4,95%CI(-1.7,2.5)〕或提高生活质量〔WMD=0.4,95%CI(-0.9,1.7)〕等方面均是无效的。对于髋关节炎或膝关节炎患者,扑热息痛在短期内减轻疼痛〔WMD=-3.7,95%CI(-5.5,1.9)〕、失能〔WMD=-2.9,95%CI(-4.9,0.9)⺗方面有显著作用,尽管在临床意义上不重要。报告任何不良反应〔HR=1.0,95%CI(0.9,1.1)〕、任何严重不良反应〔HR=1.2,95%CI(0.7,2.1)〕或因为不良事件退出研究〔HR=1.2,95%CI(0.9,1.5)〕的患者数量,在扑热息痛组和安慰剂组中类似。坚持治疗的患者数量〔HR=1.0,95%CI(0.9,1.1)〕和使用急救药物〔HR=0.7,95%CI(0.4,1.3)〕的患者数量,在两组之间也是相似的。扑热息痛组患者发生肝功能异常的概率是安慰剂组患者的4倍〔HR=3.8,95%CI(1.9,7.4)〕,但这种效应的临床意义是不确定的。结论扑热息痛在治疗腰痛方面是无效的,但可以对骨关节炎患者提供最小的短期利益。现有的临床实践指南推荐对下腰痛患者、髋关节或膝关节骨关节炎患者使用扑热息痛治疗,以上研究结果支持对这些推荐进行重新审议。
[Abstract]:Objective to investigate the efficacy and safety of paracetamol (paracetamol) in the treatment of spinal pain and osteoarthritis. Design system review and meta-analysis. Data source: Medline, Netherlands Medical Abstract Database EMBase CINAHLN Web of Science LILACS.International Pharmaceutical Abstracts Cochrane controlled trial Center Registry, built from December 2014. A randomized controlled trial was required to compare the efficacy and safety of paracetamol and placebo in the treatment of spinal pain (neck pain or low back pain) and osteoarthritis (hip, knee joint). Data were extracted by two independent researchers on pain, disability and quality of life. Secondary outcome measures included adverse reactions, patient compliance, and the use of first aid drugs. The pain and disability score was converted to a value of 0 (no pain or disability) to 100 (pain aggravation and disability). The weighted mean difference (WMD) or risk ratio (HRR) and 95% confidence interval (95% CI) were calculated by the stochastic effect model. The bias risk was evaluated by Cochrane collaboration tool, the quality of evidence was evaluated by Grade method, and the conclusions were summarized. Results A total of 12 reports were included in 13 randomized trials. For patients with low back pain, paracetamol was ineffective in reducing pain intensity in a short period of time, such as reducing pain intensity (WMD-0.9 ~ 1.9), incapacitating WMD-0.45 ~ (95) CI-1.72.5) or improving the quality of life (WMD-0.44 ~ 95CI-0.91.7). For patients with hip arthritis or knee arthritis, paracetamol relieves pain in a short period of time. This aspect has a significant effect, although it is not important in clinical sense. The number of patients who reported any adverse reactions (HR1. 0. 9 / 1.1, HR1. 2 / 95) or withdrawal from the study because of adverse events were similar to those in the paracetamol group and placebo group (P & lt; 0.05). The number of patients who reported any adverse reactions were similar to those in the paracetamol group and the placebo group, and the number of patients who withdrew from the study because of adverse events was similar to that in the paracetamol group and the placebo group. The number of patients who insisted on the treatment was similar between the two groups. The number of patients who were treated with HR1. 0. 9% and 1. 1%) and with the first aid drug HR0. 7 / 95% CI 0. 4 / 1. 3) were also similar between the two groups. The incidence of hepatic dysfunction in paracetamol group was 4 times higher than that in placebo group, but the clinical significance of this effect was uncertain. Conclusion Paracetamol is ineffective in the treatment of low back pain, but it can provide minimal short-term benefits for osteoarthritis patients. Current clinical practice guidelines recommend paracetamol therapy for patients with low back pain, hip or knee osteoarthritis, and these findings support a review of these recommendations.
【分类号】：R684;R681.5

【相似文献】