针灸治疗慢性疲劳综合征的文献研究

发布时间：2018-07-04 23:42

本文选题：针灸 + 慢性疲劳综合征　；参考：《成都中医药大学》2016年硕士论文

【摘要】：背景：慢性疲劳综合征(CFS)是临床常见的疾病之一,发病率逐年升高,严重影响患者的生活质量。针灸治疗CFS方法丰富,但由于尚且缺乏高质量的研究证据,目前针灸治疗CFS的临床疗效尚不明确。此外,其处方选穴特点及配伍规律还不够清晰,不利于最佳处方的应用和疗效的提高。目的：运用系统评价和Meta-分析的方法,评价针灸治疗CFS的临床疗效和安全性；构建CONSORT和STRICTA赋分赋权方案,详细分析针灸治疗CFS随机对照试验(RCT)的报告质量；运用数据挖掘技术分析针灸治疗CFS的选穴和配伍规律,为临床治疗及研究提供优化证据。方法：1.系统评价和Meta-分析方法：运用Cochrane系统评价方法检索Pubmed、 Embase、Cochrane library、CBM等数据库,依照纳入/排除标准进行严格筛选,运用Cochrane handbook5.1推荐的偏倚风险评估工具对最终纳入的文献进行偏倚风险评估,运用Revman5.2软件对符合标准的随机对照试验(RCTs)结果进行Meta分析,采用GRADE profiler 3.6软件对基于各结局指标证据群的质量进行评级。2.RCT报告质量分析方法：基于1996年、2001年、2010年三个版本的CONSORT,以及2001年、2010年两个版本的STRICTA,拟定各条目的赋分方案和赋权方案；对针灸治疗CFS的RCT进行文献检索和严格筛选,根据上述标准对最终纳入的文献逐条赋分、赋权；采用Microsoft Excel 2007和SPSS 21.0对各条目的加权得分进行统计分析,对针灸治疗CFS的RCT报告质量进行分析。3.数据挖掘方法：系统检索和严格筛选后,建立针灸处方数据库,运用“针灸数据挖掘系统V1.0”分析处方选穴和配伍规律。结果：1.系统评价结果：①最终纳入9篇文献,共730例患者。②毫针刺与安慰针刺对照：Chalder疲劳量表总分[WMD=-8.19,95%CI (-10.62,-5.76)],疲劳严重程度量表评分[WMD=-4.96,95%CI(-11.83,1.91)],SF-36生活质量量表总效应量[WMD=10.78,95%CI(6.01,15.55)],躯体和心理健康报告评分[WMD=-2.75,95%CI(-5.94,0.44)],VAS疼痛评分[WMD=-34.69,95%CI(-70.89, 1.51)]。③毫针刺与静脉滴注对照：Chalder疲劳量表总分[WMD=-1.93,95%CI (-2.75,-1.11)]。④电针与安慰电针对照：疲劳严重程度量表评分[WMD=-12.87, 95%CI(-15.86,-9.88)],SF-36生活质量量表总效应量[WMD=17.15,95%CI (15.54,18.76)],躯体和心理健康报告评分[WMD=-6.94,95%CI(-8.67,-5.21)], VAS疼痛评分[WMD=-11.33,95%CI(-16.56,-6.10)].⑤毫针刺与安慰针刺对照中以Chalder量表、FSS评分、SPHERE量表、SF-36为结局指标的证据质量为中级,以VAS疼痛量表为结局指标的证据质量为低级；毫针刺与静脉滴注对照中以Chalder量表为结局指标的证据质量为中级；电针与安慰电针对照中以FSS评分、SPHERE量表、SF-36、VAS疼痛量表为结局指标的证据质量为中级。⑥6项研究未提及不良事件发生情况,3项研究无不良事件。2.RCT报告质量评价结果：最终纳入34篇文献,①CONSORT评分结果：所纳入研究报告质量总平均分为133.68分(换算成百分制为40.63分),文题和摘要、引言、方法、结果、讨论、其他信息六部分平均分分别为5.38分、5.32分、3.38分、3.69分、5.67分、0.29分；②STRICTA评分结果：所纳入研究报告质量总平均分为94.39分(换算成百分之为56.86分),针刺治疗的合理性、针刺细节、治疗方案、辅助干预措施、治疗师的背景、对照或对照干预六部分平均分分别为5.25分、6.03分、9.12分、3.16分、0.15分、5.88分；③CONSORT和STRICTA分层分析结果：以“是否为2010年前发表的论文”和“是否为中文核心期刊收录论文”为分层因子的分析结果均显示差异无统计学意义(均P0.05),以“是否为学位论文”和“是否有基金资助”为分层因子的分析结果均显示差异有统计学意义(均P0.05)。3.数据挖掘结果：共纳入文献196篇,针灸处方218条,共使用腧穴43个,使用总频次1377次；单腧穴使用频次和支持度前五位是足三里(136/62.4%)、肾俞(92/42.2%)、脾俞(86/39.4%)、肝俞(84/38.5%)、三阴交(78/35.8%)；“足三里+三阴交”在两穴配伍项集支持度最高,“三阴交→内关”在两穴配伍项集置信度最高,“足三里+三阴交+百会”在三穴配伍项集支持度和置信度均最高,“足三里+关元+肾俞+脾俞”在四穴配伍项集支持度和置信度均最高。结论：1.毫针刺在降低Chalder疲劳量表得分上优于安慰针刺和静脉滴注,在降低FSS得分、SPHERE得分、VAS疼痛得分,提高SF-36得分上优于安慰针刺；电针在降低FSS得分、SPHERE得分、VAS疼痛得分,提高SF-36得分上优于安慰电针。但其研究结果的GRADE证据等级不高,且纳入的试验较少,故该研究结论需谨慎对待。2.今后针灸治疗CFS的RCT应在随机方法及分配隐藏的实施、样本量的估算、统计学方法的运用、试验方案的调整和相关信息报告、辅助干预措施、治疗师的背景、针刺细节等方面加强报告质量;CONSORT和STRICTA赋分、赋权方案的构建使针灸干预的临床研究的报告质量评价内容更丰富、结果更精准,对完善针灸临床试验设计和报道的指导性更强。3.针灸治疗CFS以辨病取穴为主,多选用足阳明胃经、足太阳膀胱经和足太阴脾经腧穴,重视补益穴和背俞穴的使用；在配伍上以足三里穴与上述诸经腧穴配伍为基本配伍,运用表里经配穴法、交会经配穴法和三部配穴法,充分体现了从脾肾入手,重视先后二天的调理治疗CFS的学术思想。
[Abstract]:Background: chronic fatigue syndrome (CFS) is one of the common clinical diseases. The incidence of the disease is increasing year by year, which seriously affects the quality of life of the patients. The method of acupuncture and moxibustion for the treatment of CFS is rich, but the clinical efficacy of acupuncture and moxibustion for the treatment of CFS is still unclear because of the lack of high quality evidence. Besides, the characteristics of the selection of the prescription and the compatibility of the prescription are not enough. Clear, not conducive to the application of the best prescription and the improvement of curative effect. Objective: To evaluate the clinical efficacy and safety of acupuncture and moxibustion for the treatment of CFS by means of systematic evaluation and Meta- analysis; to construct the CONSORT and STRICTA assigning empowerment scheme, and to analyze the quality of the report of CFS randomized controlled trial (RCT) in the treatment of acupuncture and moxibustion, and to analyze the application of data mining technology. Acupuncture and moxibustion treatment of CFS in the selection of acupoints and compatibility rules provide optimal evidence for clinical treatment and research. Methods: 1. systematic evaluation and Meta- analysis methods: using Cochrane system evaluation method to retrieve Pubmed, Embase, Cochrane library, CBM and other databases, strictly screening according to the inclusion / exclusion criteria, using Cochrane handbook5.1 recommended deviation. The risk assessment tool was based on the bias risk assessment of the final literature, using the Revman5.2 software to carry out Meta analysis on the results of the standard randomized controlled trial (RCTs), and using GRADE profiler 3.6 software to evaluate the quality of the.2.RCT report based on the quality of the evidence groups based on the outcome indicators: Based on 1996, 2001, 2010. The three versions of CONSORT, as well as the two versions of STRICTA in 2001, and the two version of the 2010, draw up various purposes and empowerment schemes. The literature retrieval and strict screening of the RCT for the acupuncture and moxibustion treatment of CFS are classified and weighted according to the above criteria, and the weight of Microsoft Excel 2007 and SPSS 21 is weighted for each purpose. The score was statistically analyzed, and the quality of the RCT report of CFS was analyzed by.3. data mining methods: after systematic retrieval and strict screening, the database of acupuncture and moxibustion prescription was established and the "acupuncture data mining system V1.0" was used to analyze the rules of prescription selection and compatibility. Results: 1. the results were as follows: (1) the final inclusion of 9 literature, a total of 730 cases Patients. (2) needling needles and consolation needles: Chalder total score [WMD=-8.19,95%CI (-10.62, -5.76)], fatigue severity scale score [WMD=-4.96,95%CI (-11.83,1.91)], SF-36 quality of life scale [WMD=10.78,95%CI (6.01,15.55)), physical and mental health report score [WMD=-2.75,95%CI (-5.94,0.44)], VAS pain Score [WMD=-34.69,95%CI (-70.89, 1.51)]. (3) needle puncture and intravenous drip control: Chalder Fatigue Scale total score [WMD=-1.93,95%CI (-2.75, -1.11)]. (4) electroacupuncture and consolation electroacupuncture: Fatigue Severity Scale score [WMD=-12.87, 95%CI (-15.86, -9.88)], SF-36 quality of life scale total effect [WMD=17.15,95%CI), body The body and mental health report score [WMD=-6.94,95%CI (-8.67, -5.21)], VAS pain score [WMD=-11.33,95%CI (-16.56, -6.10)]. 5. The evidence quality of the FSS score, SPHERE scale, SF-36 as the outcome index is intermediate, and the evidence quality of the VAS pain scale is low; The evidence quality of the Chalder scale as the result of the Chalder scale was intermediate, the quality of the evidence was FSS, the SPHERE scale, the SF-36, and the VAS pain scale were intermediate. 6. No adverse events were mentioned in the 6 studies, and the quality evaluation of the.2.RCT report without adverse events was evaluated in 3 cases. Results: the final inclusion of 34 papers, (1) CONSORT score results: the total quality of the study report was divided into 133.68 points (the conversion rate of 40.63). The article and summary, introduction, method, result, discussion, and other six parts were divided into 5.38, 5.32, 3.38, 3.69, 5.67, 0.29, and the results of STRICTA score were: The total quality of the study was divided into 94.39 points (56.86 points in conversion), the rationality of acupuncture treatment, the details of acupuncture, the treatment scheme, the intervention measures, the background of the therapist, the control or the control intervention in six parts, 5.25 points, 6.03 points, 9.12 points, 3.16, 0.15, 5.88 points; (3) CONSORT and STRICTA stratification points. Analysis results: the analysis results of "whether the papers published before 2010" and "whether the papers included in Chinese Core Journals" as stratified factors showed no statistical difference (all P0.05). The results of semantic (mean P0.05).3. data mining: 196 articles were included, 218 acupuncture prescriptions were used, 43 acupoints were used, and 1377 times were used. The use frequency and support of the single acupoints were Zusanli (136/62.4%), Shenshu (92/42.2%), spleen Yu (86/39.4%), 84/38.5%, 78/35.8%, and "Zusanli + three yin" at the two points. The support degree of the combination item is the highest, and the reliability of the two acupoint compatibility is the highest. The support degree and confidence degree of "Zusanli + three yin" and "Baihui" in the three acupoints are the highest. "Zusanli + Guan yuan + Shenshu + splenic Yu" in the four acupoints support degree and confidence degree are the highest. Conclusion: 1. needle prickles in the reduction of Chalder The fatigue scale was superior to consolation acupuncture and intravenous drip. It was superior to consolation acupuncture in reducing FSS score, SPHERE score, VAS pain score and improving the score of SF-36; Electroacupuncture was superior to consolation electroacupuncture in reducing FSS score, SPHERE score, VAS pain score, and improving SF-36 score, but the results of GRADE evidence were not high, and included in the test. The results of the study are less. Therefore, the conclusion of the study should be carefully treated with.2. in the treatment of CFS's RCT in the future of acupuncture and moxibustion treatment in random methods and distribution, the estimation of the sample size, the use of statistical methods, the adjustment of the test scheme and the related information report, the auxiliary intervention measures, the therapist's background, the details of acupuncture, and so on; CONSORT and STRICTA The construction of the empowerment scheme makes the evaluation of the clinical research report of acupuncture and moxibustion more accurate, more accurate, more guidance for improving the design and reporting of clinical trials of acupuncture and moxibustion,.3. acupuncture and moxibustion treatment CFS to identify the main points of the disease, choose Foot Yangming stomach meridian, foot sun bladder meridian, foot Taiyin spleen meridian acupoint, pay attention to tonifying point and The use of the back Shu point; the compatibility of the Zusanli point with the acupoints of the acupoints in the compatibility of the combination of the acupoints of the Zusanli and the method of acupoints with the acupoint with the meridian, the intersection of the meridians and the three points with the acupoint method, which fully embodies the academic thought of the treatment of CFS from the spleen and kidney for two days.
【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】：R246.1

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