中西医结合治疗Graves眼病的系统评价

发布时间：2018-03-30 08:47

本文选题：中西医结合　切入点：Graves眼病　出处：《山东中医药大学》2017年硕士论文

【摘要】：目的:系统评价中西医结合治疗Graves眼病的临床疗效。方法:通过计算机及手工检索对1986年12月—2016年12月期间国内外公开发表的、采用中西医结合与西药对照治疗Graves眼病的临床随机对照试验的相关文献研究进行搜集,并按照纳入、排除标准选出符合要求的文献。采用Cochrane协作网系统评价手册、运用软件Revman5.3对文献进行系统评价,并运用SPSS 23.0进行用药规律分析。结果:本研究共筛选出21篇符合纳入标准的文献,共计纳入研究样本量1262例,其中试验组665人,对照组597人。分析结果:总有效率:相对危险度RR值=1.48,95%CI(1.37,1.60),RR合并假设检验Z=9.93,P0.00001,说明中西医结合治疗Graves眼病总有效率优于单纯西药组;甲状腺功能FT4:SMD=-0.25,95%Cl是(-0.43,-0.07),总体效应检验Z=2.70,P=0.0070.05,表明中西医结合法在改善患者FT4的实验室指标上优于西药组;眼突度分析:SMD=-0.86,95%Cl是(-1.21,-0.50),总体效应检验Z=4.74,P0.00001,表明中西医结合法在改善患者眼突度的指标上优于西药组;视力分析:SMD=0.40,95%Cl是(0.10,0.70),总体效应检验Z=2.58,P=0.010.05,表明中西医结合法在改善患者视力上优于西药组;CAS评分:SMD=-1.22,95%Cl是(-2.28,-0.17),总体效应检验Z=2.27,P=0.020.05,即中西医结合法在改善患者CAS评分上优于西药组。安全性分析:比值比OR=0.28,95%CI(0.15,0.55),OR合并假设检验Z=3.75,P=0.00020.5,中西医结合组不良反应发生率为10%,西药组不良反应发生率为24%,即中西医结合组比西药组在治疗Graves眼病过程中安全性更好。结论:中西医结合法治疗Graves眼病在总有效率、FT4及眼突度、视力、CAS评分的改善方面优于西药,且不良反应发生率低,但在FT3及TSH的改善上无明显差异;由于本研究纳入文献的数量较少,存在一定局限性,且纳入文献的质量评价较低,存在一定的风险偏倚,因此还需要进一步多中心、大样本的RCT研究来进一步证实。
[Abstract]:Objective: to evaluate the clinical efficacy of integrated traditional Chinese and western medicine in the treatment of Graves ophthalmopathy. The literature about randomized controlled clinical trials of Graves ophthalmopathy treated by combination of traditional Chinese and western medicine and western medicine were collected and selected according to the inclusion and exclusion criteria. The systematic evaluation manual of Cochrane cooperation network was used. The systematic evaluation of the literature was carried out by software Revman5.3, and the rule of drug use was analyzed by using SPSS 23.0.Results: a total of 21 articles conforming to the inclusion criteria were selected in this study, and 1262 samples were included in the study, among which 665 were in the experimental group. Results: the total effective rate: the relative risk RR value was 1.48% ~ 95% ~ 1.37 ~ 1.60% / RR combined with hypothesis test Zang 9.93% P0.00001, which indicated that the total effective rate of integrated Chinese and western medicine in the treatment of Graves ophthalmopathy was better than that in the western medicine group. The thyroid function FT4: SMD-0.2595 Cl was 0.43% -0.07%. The overall effect test showed that the integrated Chinese and western medicine method was superior to the western medicine group in improving the laboratory index of FT4. The total effect of the total effect test was Zhe 4.74 (P 0.00001), which indicated that the combined Chinese and western medicine was superior to the western medicine group in improving the index of the patients' ophthalmic protrusion. The results showed that the total effect of the combined Chinese medicine and western medicine was better than that of the western medicine group in improving the degree of ophthalmic protrusion. The overall effect test showed that the integrated Chinese and western medicine method was superior to the western medicine group in improving the visual acuity of the patients. The results showed that the score of the Chinese and Western medicine group was better than that of the western medicine group. The overall effect test was Z2.27 P0. 020.05, that is, the combination of traditional Chinese and western medicine was superior to the western medicine group in improving the CAS score of the patients. Safety analysis: the ratio was 0.2895 / 0. 15 / 0.55 / OR combined with hypothesis test. The incidence of adverse reactions was 10 in the integrated Chinese and western medicine group, and 24 in the western medicine group, that is, the safety of the combined Chinese and western medicine group was better than that of the western medicine group in the treatment of Graves ophthalmopathy. Conclusion: the total effective rate of treatment of Graves ophthalmopathy with integrated traditional Chinese and western medicine is FT4 and the degree of ophthalmopathy. The improvement of visual acuity score was better than that of western medicine, and the incidence of adverse reactions was low, but there was no significant difference in the improvement of FT3 and TSH. There is a certain risk bias, so further multicenter, large sample RCT studies are needed to further confirm.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R581;R771.3

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