益气温阳固表法治疗变应性鼻炎系统评价

发布时间：2018-06-20 16:47

本文选题：变应性鼻炎 + 益气　；参考：《广州中医药大学》2016年硕士论文

【摘要】：目的：1.对益气温阳固表法治疗变应性鼻炎的随机对照试验研究进行检索与质量评价,为与之相关临床研究提供更深入的方法学指导意见。2.对益气温阳固表法治疗变应性鼻炎的随机对照试验的结局指标和安全性进行系统评价或meta-分析,为益气温阳固表法治疗变应性鼻炎的疗效和安全性提供循证依据。方法：全面检索PUBMED. EMbase、Cochrane library、 CNKI.万方、CBM、维普等国内外主要数据库,按纳入排除标准从中筛选出以益气温阳固表法治疗变应性鼻炎的RCT,进行资料提取、质量评价,而后将纳入研究的结局指标输入REVMAN5.3软件进行统计分析。结果：文献偏倚风险评估：(1)单项研究评估：13项研究中,偏倚风险单项试验评价偏倚风险(5个低、2个不确定)有1项研究。偏倚风险(4个低、1个高和2个确定)有3项研究。偏倚风险(3个低、3个不确定、1个高)有1项研究。偏倚风险(2个低、4个不确定、1个高)有7项研究。偏倚风险(1个低、4个不确定、2个高)有1项研究。最终认定4项研究属于低偏倚风险,剩余9项研究为偏倚风险高的可能性大。(2)偏倚风险汇总评估：偏倚风险不确定占汇总风险的47%,低偏倚风险占汇总风险的38%.高偏倚风险占汇总偏倚风险的14%。因此,13项研究总体偏倚风险为不确定可能性大。2.结局指标分析：主要结局指标：12项研究采用了临床有效率作为结局指标,3个亚组,共1010例,采用RR作为效应指标。各亚组间Meta分析得到RR=1.26,95%CI[1.12,1.42],差异有统计学意义(P0.001)。次要结局指标：(1)4项研究采用了复发率作为结局指标,共267例,选用Fixed Effects Models处理,合并的统计量RR=0.35,95%CI [0.25,0.51],差异有统计学意义(P0.00001)。(2)鼻部症状体征积分：3项研究的结局指标采用了鼻部症状体征总评分,共166例,用均数差(MD)作为效应指标。用Random Effects Models,合并后的效应量MD=1.58,95%CI [1.31,1.85],差异有统计学意义(P＜0.0001)。6项研究采用了鼻塞积分作为结局指标,共422例,选用Fixed Effects Models,合并后的效应量MD=0.34,95%CI [0.25,0.43],差异有统计学意义(P0.00001)。5项研究采用了喷嚏积分作为结局指标,共340例,选用Fixed Effects Models,合并后的效应量MD=0.33,95%CI [0.24,0.43],差异有统计学意义(P0.00001)。5项研究采用了流涕积分作为结局指标,共340例,选用Fixed Effects Models合并后的效应量MD=0.40,95%CI [0.30,0.50],差异有统计学意义(P0.00001)。5项研究采用了鼻痒积分作为结局指标,共340例,选用Fixed Effects Models,合并后的效应量MD=0.21,95%CI [0.11,0.32],差异有统计学意义(P0.0001)。5项研究采用了鼻部体征积分作为结局指标,共294例,选用Fixed Effects Models,合并后的效应量MD=0.23,95%CI[0.15,0.31],差异有统计学意义(P0.0001)。安全性：仅有1项研究进行了安全性报道,产生不良反应,对症治疗后可完成试验。其余12项研究均无对不良反应或者安全性的进行描述。结论：据目前研究所示,益气温阳固表法治疗变应性鼻炎疗效较高,能改善鼻部症状体征,降低复发率低,且未见的不良反应报道。但因为纳入的文献方法学质量参差不齐,研究间存在异质性,偏倚风险不能确定,故使结论的可信度降低。尚需要样本量大、方法学质量高的临床试验来证实益气温阳固表法治疗变应性鼻炎的疗效和安全性。
[Abstract]:Objective: 1. a randomized controlled trial for the treatment of allergic rhinitis was carried out in a randomized controlled trial to evaluate the quality of a randomized controlled trial for allergic rhinitis, and to provide a more in-depth methodological guidance for the related clinical studies. The systematic evaluation and safety of the randomized controlled trial on the treatment of allergic rhinitis by.2. was systematically evaluated or meta- In order to provide evidence-based evidence for the efficacy and safety of the treatment of allergic rhinitis by supplementing qi and warming Yang table method. Methods: a comprehensive retrieval of PUBMED. EMbase, Cochrane library, CNKI. Wanfang, CBM, VP and other major databases at home and abroad were selected. According to the exclusion criteria, we screened out RCT for allergic rhinitis with the method of Warming Yang and warming yang to treat allergic rhinitis. Take, quality evaluation, and then put the outcome indicators into the REVMAN5.3 software for statistical analysis. Results: Literature bias risk assessment: (1) single study assessment: 13 studies, bias risk single test evaluation of bias risk (5 low, 2 indeterminate) have 1 studies. Bias risk (4 low, 1 high and 2 determine) 3 research There were 1 studies on bias risk (3 low, 3 indeterminate, 1 high). Bias risk (2 low, 4 uncertainty, 1 high) had 7 studies. Bias risk (1 low, 4 uncertainty, 2 high) had 1 studies. The bias risk uncertainty accounted for 47% of the aggregate risk, and the 38%. high bias risk of the low bias risk accounted for the 14%. of the aggregate bias risk, so the total bias risk of the 13 studies was an indefinite possibility of the large.2. outcome index analysis: the main outcome index: the 12 studies adopted the bed efficiency as the outcome index, 3 subgroups, and 101 0 cases, using RR as the effect index, Meta analysis between the subgroups obtained RR=1.26,95%CI[1.12,1.42], the difference was statistically significant (P0.001). Secondary outcome indicators: (1) 4 studies used the recurrence rate as the outcome index, a total of 267 cases, Fixed Effects Models treatment, the combination of RR=0.35,95%CI [0.25,0.51], the difference was statistically significant (P0.00001). (2) nasal symptoms and signs points: the outcome indicators of the 3 studies used the total score of nasal symptoms and signs, 166 cases, and the average number difference (MD) as the effect index. Random Effects Models, the combined effect of MD=1.58,95%CI [1.31,1.85], the difference has the significance of total count (P < 0.0001).6 study using the nasal plug integral as The outcome index, 422 cases, Fixed Effects Models, combined effect of MD=0.34,95%CI [0.25,0.43], the difference was statistically significant (P0.00001).5 study using the sneezing integral as the outcome index, a total of 340 cases, selected Fixed Effects Models, the combined effect MD=0.33,95%CI [0.24,0.43], the difference was statistically significant. The.5 study used the runny score as the outcome index, 340 cases, and the effect of Fixed Effects Models combined with MD=0.40,95%CI [0.30,0.50], the difference was statistically significant (P0.00001).5 item study used the nose itch integral as the outcome index, a total of 340 cases, Fixed Effects Models, the combined effect magnitude MD=0.21,95%CI .32], the difference was statistically significant (P0.0001).5 study used the nasal signs integral as the outcome index, a total of 294 cases, selected Fixed Effects Models, the combined effect of MD=0.23,95%CI[0.15,0.31], the difference was statistically significant (P0.0001). The safety: only 1 studies carried out safety reports, adverse reactions, symptomatic treatment after the treatment. The other 12 studies have no description of adverse reactions or safety. Conclusion: according to the present study, the therapeutic effect of Yiqi warming and positive fixation on allergic rhinitis is higher. It can improve the signs of nasal symptoms, reduce the low recurrence rate and no adverse reaction, but the quality of the included literature methodology is not good. Qi, there is heterogeneity among the studies, the risk of bias cannot be determined, so that the credibility of the conclusion reduced. Still need a large sample size, the efficacy and safety of methodological quality of clinical trials to prove beneficial high temperature Yang Gubiao method in the treatment of allergic rhinitis.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R276.1

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