单纯灸法干预腰椎间盘突出症临床疗效与安全性的Meta分析

发布时间：2018-02-04 13:25

本文关键词： 腰椎间盘突出症单纯灸法随机对照试验 Meta分析　出处：《辽宁中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:运用Meta分析对应用单纯灸法治疗腰椎间盘突出症患者的临床疗效及安全性进行系统评价。材料与方法:计算机检索Pubmed、Embase、中国生物医学文献数据库(CBM)、相关期刊论文(CNKI)、中文期刊全文数据库(VIP)、万方数字化期刊全文数据库(WANFANG DATA),检索年限至2016年11月,纳入运用单纯灸法治疗腰椎间盘突出症,对照组采用常规针刺、牵引推拿、中药熏蒸、中成药、西药等其他手段治疗的随机对照试验为研究对象,由2名研究者通过阅读文章题目和摘要,并结合全文,对文献进行资料提取,应用Revman 5.3软件对临床疗效与安全性进行Meta分析。结果:本研究共纳入文献28篇,均为随机对照试验,共纳入2429例患者,试验组1254例,予单纯隔物灸治疗;对照组1175例,予常规针刺、牵引推拿、中药熏蒸、中成药、西药等其他手段治疗,治疗疗程不限。纳入所有原始研究均提及采用随机方法,其中12篇文献采用随机数字表法,1篇文献采用密闭信封分配隐藏,1篇文献采用单盲设计,5篇文献对于失访/退出原因予以说明,纳入研究的存在一定的选择、实施以及测量偏倚。采用改良Jadad量表对纳入的28篇原始研究进行评价,其中高质量文献共计12篇,低质量文献共计16篇。所有文献均对数据进行统计处理。Meta分析结果显示:单纯灸法的临床疗效优于对照组(RR=1.16,95%CI(1.11,1.21),P0.00001);在降低腰椎间盘突出症患者随访复发情况明显优于对照组(RR=0.31,95%CI(0.16,0.62),P=0.0009);在减轻腰椎间盘突出症患者VAS评分方面与对照组比较差异具有统计学意义(WMD=-1.17,95%CI(-1.56,-0.78),P0.00001);在增强腰椎间盘突出症患者腰椎功能评分方面与对照组比较差异具有统计学意义(SMD=3.65,95%CI(2.43,4.88),P0.00001);在增强腰椎间盘突出症患者M-JOA评分方面与对照组比较差异具有统计学意义(WMD=2.31,95%CI(0.87,3.76),P=0.002);同时能够降低腰椎间盘突出症患者的血清IL-6含量(SMD=-0.62,95%CI(-0.98,-0.25),P=0.0010)。结论:单纯灸法能够有效减轻腰椎间盘突出症患者的疼痛,改善临床症状,降低随访复发情况,但本次纳入的文献质量一般,本次分析仍具有一定的局限性,仍需进一步进行合理的多中心随机双盲对照实验进行评价。
[Abstract]:Objective: to evaluate the efficacy and safety of moxibustion alone in the treatment of lumbar disc herniation by Meta. Materials and methods: Pubmedmedan Embase was searched by computer. China Biomedical Literature Database (CBM), China Journal Full-text Database (CNKI), Chinese Journal Full-text Database (VIP). Wanfang digital periodical full-text database WANFANG DATAA, the retrieval time to November 2016, included the treatment of lumbar disc herniation by moxibustion alone, the control group was treated with routine acupuncture. Traction massage, Chinese medicine fumigation, Chinese patent medicine, western medicine and other means of randomized controlled trials, by two researchers by reading the title and summary of the article, and combined with the full text of the literature data extraction. The clinical efficacy and safety were analyzed by Meta with Revman 5.3 software. Results: 28 articles were included in this study, all of them were randomized controlled trials, and 2 429 patients were included in this study. In the experimental group, 1254 cases were treated with moxibustion only. In the control group, 1175 cases were treated with routine acupuncture, traction massage, traditional Chinese medicine fumigation, Chinese patent medicine, western medicine, etc. The course of treatment was unlimited. Among them, 12 articles were randomly listed and 1 document was allocated and hidden by closed envelopes. One document was designed with a single blind design and 5 articles were used to explain the reasons for the loss or withdrawal of the interview. The selection, implementation and measurement of bias in the inclusion study were evaluated with the modified Jadad scale for 28 original studies, of which 12 were of high quality. The results of statistical analysis showed that the clinical effect of moxibustion alone was better than that of control group (RRX 1.16). 95. CII 1.11, 1.21, P0.00001; In the patients with lumbar disc herniation, the rate of follow-up and recurrence was significantly better than that of the control group. Compared with the control group, the VAS score of the patients with lumbar disc herniation was significantly different from that of the control group (WMD-1.1795). P0.00001; Compared with the control group, there was a significant difference in the enhancement of lumbar function score between the patients with lumbar disc herniation and the control group (SMD3.65 / 95 CI 2.43 / 4.88). P0.00001; Compared with the control group, the M-JOA score of the patients with lumbar disc herniation was significantly higher than that of the control group (WMD2.31 / 95CI0.87 / 3.76). P0. 002; At the same time, it can reduce the serum IL-6 content of patients with lumbar disc herniation. Conclusion: moxibustion alone can effectively reduce pain, improve clinical symptoms and reduce recurrence in patients with lumbar disc herniation, but the quality of literature included in this study is general. This analysis still has some limitations, and needs to be further evaluated by multi-center randomized double-blind controlled trial.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.9

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