重症肌无力中医证候文献研究及随机对照试验文献评价研究

发布时间：2018-04-22 20:40

本文选题：重症肌无力 + 中医　；参考：《长春中医药大学》2016年硕士论文

【摘要】：目的:通过对重症肌无力中医相关文献研究,归纳总结重症肌无力中医证候、证素及不同时间段证候类型分布规律,为重症肌无力的标准化治疗提供依据,同时有关MG的临床随机对照试验文献进行质量评价,为重症肌无力中医治疗指南提供依据。方法:通过中国知识资源总库(CNKI)、万方学术期刊全文数据库、维普中文期刊数据库(VIP)、中国生物医学文献服务系统电子数据库检索,一方面搜集近30年(1986年1月-2015年12月)所有国内期刊发表的关于重症肌无力中医中文文献。从中按照纳入标准及排除标准筛选文献,从筛选后的文献中提取重症肌无力中医各证候类型及病例基本信息等建立数据库,采用Microsoft Excel频数统计方法对证候类型、证候因素及不同时间段中医证候类型分布规律等进行分析统计;另一方面收集近20年(1996年1月-2015年12月)中文期刊中所有关于重症肌无力随机对照试验研究的文献。根据纳入及排除标准筛选文献,并采用国际公认的临床试验报告的统一标准CONSORT声明的条评价标准及改良Jadad评分量表的4个标准对纳入的文献报告进行质量评价。结果:1.文献研究共纳入27篇文献,重症肌无力患者2403例。共整理出中医证候类型分别为:脾气虚证、脾肾两虚证、奇经虚损证、脾肾阳虚证、脾胃气虚证、大气下陷证、肝肾阴虚证、络脉虚滞证、脾肺虚损证、气虚血瘀证、湿热浸淫证、肾虚血瘀证、脾肾阴虚证、脾虚湿困证、阴虚血热证。其中主要的证候类型(比例≥10%)为脾气虚证、脾肾两虚证、奇经虚损证、脾肾阳虚证、脾胃气虚证。2.脾气虚证及脾肺虚损证2006-2015年所占的比例较1986-1995年明显减少;而大气下陷证及肝肾阴虚证2006-2015年所占的比例则比1986-1995年增多;奇经虚损证2006-2015年所占比例较1996-2005年明显减少;而脾胃气虚证及大气下陷证2006-2015年所占比例较1996-2005年明显增多。3.共提取出16项证素。包括病位证素(脾、肾、奇经、胃、肝、胞络、肺)7项;病性证素(气虚、阴虚、阳虚、血瘀、热、血虚、湿、气陷、津亏)9项。本病的病位多在脾、肾、奇经(比例≥5%),病性多为气虚、阴虚、阳虚(比例≥5%)。4.文献评价研究:纳入的70篇RCT文献中,没有1篇严格遵循CONSORT声明条目规范报告,Jadad评分均为低质量研究。结论：1.通过对重症肌无力中医证候、证候因素及不同时间段证候分布规律的研究,可见重症肌无力辩证分型多以脏腑辨证为主,并与病因辨证和气血阴阳辨证相结合。本病的病位以脾、肾、奇经为主,病性则多以气虚、阴虚、阳虚为多见。近年来肝肾阴虚、湿热浸淫等证候类型在重症肌无力证候中所占的比例明显增多,所以提示我们,治疗中在辨证论治、标本兼顾的基础上,病位上应重视肝肾,病性上多注重湿热等实证的防治。2.通过对MG随机对照试验研究的文献的评价,发现目前随机对照试验报告质量偏低,有必要在相关期刊上大力推广并采用CONSORT声明规范随机对照试验的报告。
[Abstract]:Objective: To summarize the TCM Syndromes of myasthenia gravis, syndrome factors and the distribution of syndrome types in different time periods, and to provide the basis for the standardized treatment of myasthenia gravis for myasthenia gravis. At the same time, the quality evaluation of MG's clinical randomized controlled trial literature was carried out for the treatment guide of myasthenia gravis. Methods: through the general database of Chinese knowledge resources (CNKI), the full text database of Wanfang academic periodicals, the database of VP Chinese Journal (VIP), and the electronic database retrieval of the Chinese biomedical literature service system. On the one hand, the Chinese literature on myasthenia gravis published in the domestic periodicals of nearly 30 years (December January 1986, -2015) has been collected. According to the inclusion criteria and exclusion criteria, a database was established to extract the types of TCM syndromes and basic information of myasthenia gravis from the selected literature. The Microsoft Excel frequency statistics were used to analyze the types of syndromes, syndrome factors and the distribution of TCM Syndrome Types in different time periods. The literature on all the randomized controlled trials of myasthenia gravis in the Chinese Periodicals of nearly 20 years (December January 1996 -2015 December) was collected. The inclusion and exclusion criteria were selected, and 4 criteria for the evaluation of the standard and the improved Jadad rating scale were incorporated into the internationally recognized clinical trial reports. Results: a total of 27 literature and 2403 cases of myasthenia gravis were included in the 1. literature study. The types of TCM syndromes were included: spleen qi deficiency syndrome, spleen and kidney two deficiency syndrome, Qi deficiency syndrome, spleen and kidney yang deficiency syndrome, spleen and stomach qi deficiency syndrome, atmospheric depression syndrome, liver kidney yin deficiency syndrome, asthenia syndrome of spleen and lung, deficiency of spleen and lung, Qi deficiency and blood stasis Syndrome, kidney deficiency and blood stasis syndrome, spleen kidney yin deficiency syndrome, spleen deficiency dampness syndrome, yin deficiency and blood heat syndrome, the main syndrome types (proportion > 10%) are spleen and kidney deficiency syndrome, spleen and kidney two deficiency syndrome, Qi deficiency syndrome, spleen and kidney yang deficiency syndrome, spleen and stomach Qi deficiency syndrome.2. spleen qi deficiency syndrome and spleen lung deficiency syndrome significantly reduced in 1986-1995 years. The proportion of qi depression syndrome and liver kidney yin deficiency syndrome for 2006-2015 years was more than 1986-1995 years, and the proportion of qi deficiency syndrome for 2006-2015 years decreased significantly than that of 1996-2005 years, while the proportion of spleen and stomach qi deficiency syndrome and the 2006-2015 years of atmospheric depression was significantly increased than that of 1996-2005 years, and 16 kinds of syndromes were extracted from the 1996-2005 years, including the spleen, kidney, and Qi meridian, including the spleen, the kidney and the Qi. 7 items of the stomach, liver, cell, lung and lung (Qi deficiency, yin deficiency, Yang deficiency, blood stasis, heat, blood deficiency, dampness, depression, Tianjin) 9 items. The disease is mostly in the spleen, kidney, and Qi (the proportion is more than 5%), most of the disease is Qi deficiency, yin deficiency, Yang deficiency (ratio > 5%).4. literature review: No 1 articles strictly follow the CONSORT statement entry standard report, Jad Ad scores were all low quality research. Conclusion: 1. through the study of TCM syndrome of myasthenia gravis, syndrome factors and the distribution of syndromes in different time periods, it is found that the dialectical classification of myasthenia gravis is mainly based on the syndrome differentiation of viscera, and combined with etiological syndrome differentiation and Qi blood Yin Yang syndrome differentiation. Qi deficiency, yin deficiency and yang deficiency are more common. In recent years, the proportion of syndromes of liver kidney yin deficiency, damp heat immersion and other syndromes in myasthenia gravis syndrome is significantly increased. Therefore, we suggest that on the basis of syndrome differentiation and treatment in the treatment, the liver and kidney should be paid much attention to on the basis of both syndrome differentiation and treatment, and the prevention and control of.2. through the MG random control test It is found that the quality of the present randomized controlled trial reports is low, and it is necessary to vigorously promote and use the CONSORT statement to standardize the report of the randomized controlled trial.

【学位授予单位】：长春中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.7

【参考文献】