基于GRADE系统的中药蒸气浴治疗KOA临床疗效的系统评价

发布时间：2018-12-06 19:59

【摘要】：目的:系统评价中药蒸气浴结合常规疗法治疗膝关节骨性关节炎的临床疗效。方法:由两名系统评价员提取检索关键词,制定科学有效的文献检索策略,运用计算机检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP)、万方数字化期刊群(WF)、Pubmed数据库中近5年的文献;所纳入文献以中药蒸气浴或中药蒸气浴疗法为主结合其他常规疗法治疗KOA为治疗组,以对应的常规疗法治疗KOA为对照组的随机对照研究,制定纳入标准和排除标准,纳入符合标准的文献18篇。根据Cochrane Handbook5.1推荐的偏倚风险评估工具,对纳入文献的质量进行评价,并运用Revman5.3软件分析收集到的数据,亚组分析则是根据结合不同的常规疗法分组,共分成4个亚组,分别是:“中药蒸气浴”亚组、“中药蒸气浴结合电针”亚组、“中药蒸气浴结合口服美洛昔康+氨基葡萄糖”亚组、“中药蒸气浴结合关节腔注射玻璃酸钠”亚组,结局评价指标采用临床有效率。制作漏斗图分析潜在的发表偏倚。再采用国际上通用的证据质量分级系统GRADE对结局指标的证据质量进行分级。结果:最终收纳18篇文献,研究共计1761名参与者参加,观察组患者共计913名,对照组患者共计848名。经Meta分析结果显示,OR=3.47,95%的CI为[2.53,4.78],其整体效果检验Z=7.67,P0.00001。漏斗图形几乎是对称的,说明偏倚风险小。亚组分析结果:“中药蒸气浴”亚组:OR=2.44,95%的CI为[1.01,5.93],整体效果检验Z=1.98,P0.00001;“中药蒸气浴结合电针”亚组:OR=2.39,95%的CI为[1.36,4.20],整体效果检验Z=3.04,P0.00001;“中药蒸气浴结合口服美洛昔康+氨基葡萄糖”亚组:OR=1.65,95%的CI为[0.68,4.02],整体效果检验Z=1.10,P=0.27,“中药蒸气浴结合关节腔注射玻璃酸钠”亚组:OR=6.20,95%的CI为[3.69,10.41],整体效果检验Z=6.90,P0.00001。GRADE分级结果:中药蒸气浴结合常规疗法与单纯采用常规疗法治疗膝关节骨性关节炎的证据等级为低级,“中药蒸气浴”亚组的证据等级为极低级,“中药蒸气浴结合电针”亚组的证据等级为低级,“中药蒸气浴结合口服美洛昔康+氨基葡萄糖”亚组的证据等级为极低级,“中药蒸气浴结合关节腔注射玻璃酸钠”亚组的证据等级为低级。结论:中药蒸气浴结合常规疗法治疗膝关节骨性关节炎的疗效优于单纯采用常规疗法;“中药蒸气浴”、“中药蒸气浴结合电针”、“中药蒸气浴结合关节腔注射玻璃酸钠”的疗效均优于单纯采用常规疗法;不能说明“中药蒸气浴结合口服美洛昔康+氨基葡萄糖”的疗效优于“口服美洛昔康+氨基葡萄糖”;但是系统评价结果的GRADE分级均为低级和极低级,证据级别较低,同时需要提供更多大规模、多中心、高质量随机对照试验进行论证。
[Abstract]:Objective: to evaluate the clinical effect of steam bath combined with routine therapy on knee osteoarthritis. Methods: the key words were extracted by two system evaluators, and a scientific and effective document retrieval strategy was formulated. (CNKI), Chinese biomedical literature database, (CBM), Weip database (VIP), was searched by computer. The literature in the (WF), Pubmed database of Wanfang Digital Journals Group in recent 5 years; The included literature included traditional Chinese medicine steam bath or traditional Chinese medicine steam bath therapy combined with other conventional therapy for KOA as the treatment group, and the corresponding routine therapy for KOA as the control group as a randomized controlled study, the inclusion criteria and exclusion criteria were established. There were 18 articles which met the standard. According to the bias risk assessment tool recommended by Cochrane Handbook5.1, the quality of the literature was evaluated, and the collected data were analyzed using Revman5.3 software. The subgroup analysis was divided into four subgroups according to the combination of different conventional therapies. They were: "Chinese medicine steam bath" subgroup, "traditional Chinese medicine steam bath combined with electroacupuncture" subgroup, "traditional Chinese medicine steam bath combined with oral meloxicam glucosamine" subgroup, "traditional Chinese medicine steam bath combined with intraarticular injection of sodium hyaluronate" subgroup, and "traditional Chinese medicine steam bath combined with oral meloxicam glucosamine" subgroup, respectively. The outcome was evaluated by clinical efficacy. Make funnel charts to analyze potential publication bias. Then the evidence quality of the outcome index is classified by the international common evidence quality classification system (GRADE). Results: a total of 1761 participants were enrolled in the study, 913 patients in the observation group and 848 patients in the control group. The results of Meta analysis showed that the CI of OR=3.47,95% was [2.53 卤4.78], and the overall effect of OR=3.47,95% was 7.67% (P 0.00001). Funnel patterns are almost symmetrical, indicating a low risk of bias. The results of subgroup analysis were as follows: the CI of OR=2.44,95% was 1.01 ~ 5.93, and the whole effect test was ZH1.98 (P0.00001). "traditional Chinese medicine steam bath combined with electroacupuncture" subgroup: the CI of OR=2.39,95% was 1.36 ~ 4.20. "Vapor Bath combined with Oral Meloxicam Glucosamine" subgroup: the CI of OR=1.65,95% was [0.68 卤4.02]. "Vapor Bath of traditional Chinese Medicine combined with Intraarticular injection of Sodium Hyaluronate" subgroup: the CI of OR=6.20,95% was [3.69 ~ 10.41]. The results of P0.00001.GRADE classification showed that the evidence level of traditional Chinese medicine steam bath combined with conventional therapy and simple routine therapy for osteoarthritis of knee joint was lower, and that of "Chinese medicine steam bath" subgroup was extremely low. The evidence level of "traditional Chinese medicine steam bath combined with electroacupuncture" subgroup was lower than that of "traditional Chinese medicine steam bath combined with oral meloxicam glucosamine" subgroup. The evidence level of the "Chinese medicine steam bath combined with intraarticular injection of sodium hyaluronate" was low. Conclusion: the curative effect of steam bath combined with conventional therapy on osteoarthritis of knee joint is better than that of simple routine therapy. The curative effect of "steam bath of Chinese medicine", "steam bath of traditional Chinese medicine combined with electroacupuncture" and "steam bath of traditional Chinese medicine combined with injection of sodium hyaluronate into joint cavity" were better than that of simple conventional therapy. It can not be concluded that "traditional Chinese medicine steam bath combined with oral meloxicam glucosamine" is better than "oral meloxicam glucosamine"; However, the GRADE ratings of the system evaluation results are all low and very low, and the evidence level is lower, and more large scale, multi center, high quality randomized controlled trials are needed to demonstrate.
【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】：R274.9

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