针灸治疗慢性咽炎的系统评价

发布时间：2018-05-29 22:47

本文选题：针灸 + 慢性咽炎　；参考：《成都中医药大学》2016年硕士论文

【摘要】：目的：检索2016年1月前针灸方法治疗慢性咽炎(排除急性咽炎)的临床随机对照试验(Randomized Controlled Trials, RCT),纳入针灸或针灸联合药物与药物治疗慢性咽炎来对照的RCT研究,通过系统评价对针灸改善慢性咽炎临床症状的疗效采取评价,分析临床取穴规律,为针灸治疗慢性咽炎的临床运用提供循证医学依据。方法：文献检索：检索国内外数据库：①中文数据库：计算机检索中国知网(1995-2016)、维普数据库(1995-2016)、万方数字化期刊(2016年1月1日以前)以及中国生物医学文献数据库(1995-2016)；②英文数据库：The Cochrane Library (2016), PubMed (1995-2016); EMBASE (1995-2016);③手工检索本校图书馆相关资料；④ http://scholar.google.com等网络资料、灰色文献数据库和会议文献数据库(CMCC)上进行补充检索。确定文献：由两名系统评价员按照本系统评价的诊断、纳入及排除标准,对资料进行提取,选出所有针灸或者针灸联合药物治疗慢性咽炎的临床随机对照实验,如遇到问题存在分歧,通过讨论或由其他方仲裁解决。数据分析：对纳入的文献依据评价员手册(5.1.0)和GRADE证据等级进行文献质量评价,再通过Cochrane协作网专用统计软件包(Review Manager 5.3.5),进行定性和meta分析。结果：(1)总共纳入21篇符合标准的文献,其总样本量为2200例受试者,试验组1145例,对照组1055例。按照干预措施分组,针灸与药物对照12篇,针灸结合基础治疗与基础治疗对照9篇；(2)主要结局指标总有效率分析,针灸与药物对照组RR=1.29,95%CI[1.22,1.36],针灸结合基础治疗与基础治疗对照组RR=1.18,95%CI[1.11,1.25];治愈率分析,针灸与药物对照组RR=1.97,95%CI[1.66,2.34],针灸结合基础治疗与基础治疗对照组RR=1.51,95%CI[1.27,1.81];(3)对针灸治疗慢性咽炎后血管内皮细胞黏附分子(VCAM-1)及血清IL-2、TNF-a进行定性分析。结论：(1)基础治疗的前提下,增加针灸疗法能提高临床总有效率及治愈率,改善症状与体征,证据等级为中级,给予推荐；(2)针灸疗法比西药更能提高慢性咽炎的总有效率及治愈率,证据等级为中级,给予推荐；(3)基础治疗前提下,加用针灸疗法可以改善咽喉部症状量表评分,但量表不够规范,证据等级不高,有待进一步研究改善；(4)针灸疗法在改善慢性咽炎血管内皮细胞黏附分子(VCAM-1)及血清IL-2、TNF-a比药物疗法更有优势,证据等级均为低级或者极低级,其临床可靠性不能评估,只能为临床提供参考,有待以后对此深入研究；(5)由于缺乏不良反应数据,无法对针灸治疗慢性咽炎安全性作出客观评价。
[Abstract]:Objective: to retrieve randomized Controlled trials (RCTs) of acupuncture and moxibustion therapy for chronic pharyngitis (excluding acute pharyngitis) before January 2016, and to include the RCT study of acupuncture and moxibustion combined with drugs and drugs in the treatment of chronic pharyngitis. The clinical effect of acupuncture and moxibustion on improving the clinical symptoms of chronic pharyngitis was evaluated through systematic evaluation, and the rule of acupoint collection was analyzed to provide evidence based medicine basis for the clinical application of acupuncture and moxibustion in the treatment of chronic pharyngitis. Methods: literature retrieval: retrieval of domestic and foreign databases: 1 Chinese database: computer retrieval of China Zhiwang (1995-2016), Weipu (1995-2016), Wanfang digital journals (before January 1, 2016) and Chinese biomedical literature database (1995-2016); (2) English database: the Cochrane Library / 2016, PubMed / 1995 / 2016; EMBASE / 1995 / 2016 / 3; 4 http://scholar.google.com and other network data, gray document database and conference document database were used for supplementary retrieval. To confirm the literature: according to the diagnosis, inclusion and exclusion criteria of the system, two systematic evaluators were selected to select all clinical randomized controlled trials of acupuncture and moxibustion combined with drugs for the treatment of chronic pharyngitis. In the event of any disagreement, the dispute shall be settled by discussion or arbitration by other parties. Data analysis: the literature quality was evaluated on the basis of the evaluator's manual 5.1.0) and the GRADE evidence grade, and then the qualitative and meta analysis was carried out through the special statistical software package of Cochrane cooperation network (Review Manager 5.3.5). Results A total of 21 articles were included. The total sample size was 2200 subjects, 1145 subjects in the trial group and 1055 in the control group. According to the intervention measures, there were 12 articles of acupuncture and drug control, 9 articles of acupuncture combined with basic treatment and 9 pieces of basic treatment. The total effective rate of the main outcome indexes was analyzed. The CI of acupuncture and moxibustion and drug control group was 1.2995 [1.221.36], and that of the control group of acupuncture and moxibustion combined with basic therapy was 1.18995 CI [1.111.25], and the cure rate was analyzed. The quantitative analysis of vascular endothelial cell adhesion molecule (VCAM-1) and serum IL-2TNF-a after chronic pharyngitis treated by acupuncture and moxibustion combined with basic therapy and basic therapy was carried out. Conclusion under the premise of basic treatment, the increase of acupuncture and moxibustion therapy can improve the total clinical effective rate and cure rate, improve the symptoms and signs, and the level of evidence is intermediate. The total effective rate and cure rate of chronic pharyngitis can be improved by acupuncture and moxibustion therapy than western medicine. The evidence grade is intermediate. Under the premise of recommended basic treatment, acupuncture and moxibustion therapy can improve the score of pharynx and larynx symptom scale. However, the scale is not standardized and the evidence level is not high. Further research is needed to improve the Acupuncture therapy in the improvement of vascular endothelial cell adhesion molecule (VCAM-1) and serum IL-2TF-a in chronic pharyngitis. Its clinical reliability can not be evaluated, can only provide a reference for clinical practice, and need to be further studied in the future. (5) due to the lack of adverse reaction data, it is impossible to make an objective evaluation on the safety of acupuncture and moxibustion in the treatment of chronic pharyngitis.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.81

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