葛根汤及其加减治疗颈椎病的系统评价与Meta分析
发布时间：2019-05-17 23:55
【摘要】：背景：颈椎病是指由于颈椎间盘退变以及由此导致的颈椎退变,引发诸如颈肩部及上肢疼痛及功能障碍、头痛、眩晕等症状的一种疾病。一般可分为颈型、神经根型、椎动脉型、脊髓型、交感神经型及混合型等。各型颈椎病严重时会出现诸如颈肩上肢的疼痛麻木、眩晕、恶心等症状,而脊髓型颈椎病会导致下肢肌力减退,严重时会出现瘫痪,严重影响患者的生活质量。中药汤剂治疗颈部不适中医古籍中早有提及,《伤寒论》中所记载的葛根汤证条文中提到“太阳病,项背强几几,无汗恶风,葛根汤主之”。其中的“项背强几几”与颈椎病的症状极为相像。目前已有不少文献研究葛根汤及其加减对颈椎病的治疗的临床随机试验,但却没有葛根汤及其加减治疗颈椎病的系统评价和Meta分析。本研究拟对葛根汤及其加减治疗颈椎病进行系统评价和Meta分析,从而用科学可信的方法评价葛根汤的有效性和安全性,探讨葛根汤的临床价值,以期用循证医学的方法为临床实践和与之相关的科学研究提供高级别的循证医学证据。目的：对葛根汤及其加减治疗颈椎病的随机对照试验进行系统评价和Meta分析,评价其疗效和安全性。用循证医学的方法为临床实践和与之相关的科学研究提供高级别的循证医学证据。方法：计算机检索中国知网(CNKI)、维普数据库(VIP)、中国生物医学文献数据库(CBM)、万方数据库、PubMed和Cochrane Library数据库。时间截止到2016年。纳入所有葛根汤及其加减治疗颈椎病的随机对照试验。使用RevMan5.3软件对纳入的文献进行Meta分析。计数资料采用优势比(odds ratio,OR),连续性变量资料采用均差(mean difference,MD)作为效应评价,并提供95%可信区间(confidence interval,CI)表示结果。当试验结果临床异质性在可接受范围内,进行定量分析,考虑到中药治疗的复杂性,选用随机效应模型。若试验结果异质性较大,则用定性分析。试图获取的结局指标：主要结局指标为(1)总有效率；(2)VAS评分。次要结局指标：(1)不良反应；(2)随访复发率。结果：共纳入32项研究。Meta分析结果显示：关于提高颈椎病的总有效率方面：1.葛根汤(加减)较单纯口服非甾体类抗炎药有优势；2单纯葛根汤(加减)较单纯口服中成药(非葛根汤或其加减)有优势；3葛根汤(加减)结合针刺较单纯针刺有优势；4葛根汤(加减)结合牵引较单纯牵引有优势；5葛根汤(加减)结合推拿手法较单纯推拿手法有优势；6葛根汤(加减)结合推拿手法较口服西药(塞来昔布胶囊)结合推拿手法有优势。且定性分析显示葛根汤(加减)可降低颈椎病疼痛的VAS评分。所有文献中未发现不良反应。治疗神经根型的文献较多,颈型和椎动脉型次之,未单独提到其他类型颈椎病。结论：葛根汤(加减)可以提高颈椎病患者的有效率,降低颈椎病疼痛的VAS评分,未发现有不良反应。且对颈椎病的神经根型,颈型,椎动脉型效果明显
[Abstract]:Background: cervical spondylosis is a disease caused by cervical disc degeneration and cervical degeneration, such as neck, shoulder and upper limb pain and dysfunction, headache, vertigo and so on. It can be divided into cervical type, nerve root type, vertebral artery type, spinal cord type, sympathetic nerve type and mixed type. When each type of cervical spondylosis is serious, there will be symptoms such as pain and numbness of neck and shoulder, vertigo, nausea and so on, while cervical Spondylotic myelopathy will lead to lower extremity muscle strength decline, severe paralysis, seriously affecting the quality of life of patients. Traditional Chinese medicine decoction has long been mentioned in the ancient books of traditional Chinese medicine for the treatment of neck discomfort, and the provisions of Pugen decoction recorded in the Treatise on febrile Diseases mentioned "Sun disease, Xiang back strong, no sweat evil wind, Pugen decoction." Among them, "Xiang back strength several" and cervical spondylosis symptoms are very similar. At present, many literatures have studied the clinical randomized trials of Gegen decoction and its addition and subtraction in the treatment of cervical spondylosis, but there is no systematic evaluation and Meta analysis of Gegen decoction and its addition and subtraction in the treatment of cervical spondylosis. In this study, Gegen decoction and its addition and subtraction in the treatment of cervical spondylosis were systematically evaluated and analyzed by Meta, so as to evaluate the effectiveness and safety of Gegen decoction with scientific and credible methods, and to explore the clinical value of Gegen decoction. In order to provide high-level evidence-based medical evidence for clinical practice and related scientific research, evidence-based medicine (EBM) is used to provide evidence-based medicine (EBM) for clinical practice and related scientific research. Objective: to evaluate the efficacy and safety of Gegen decoction and its addition and subtraction in the treatment of cervical spondylosis by systematic evaluation and Meta analysis. Evidence-based medicine (EBM) is used to provide high-level evidence-based medical evidence for clinical practice and related scientific research. Methods: the Chinese biomedical literature database (CBM), Wanfang database, PubMed database and Cochrane Library database were searched by computer. The time ends in 2016. All Gegen decoction and its addition and subtraction were included in the randomized controlled trial of cervical spondylosis. Meta analysis of the included literature was carried out by using RevMan5.3 software. The advantage ratio (odds ratio,OR) was used for counting data, and the mean difference (mean difference,MD) was used as effect evaluation for continuous variable data, and 95% confidence interval (confidence interval,CI) was provided to represent the results. When the clinical heterogeneity of the trial results is within the acceptable range, quantitative analysis is carried out, and considering the complexity of traditional Chinese medicine treatment, the random effect model is selected. If the heterogeneity of the test results is large, the qualitative analysis is used. The main outcome indexes were (1) total efficiency and (2) VAS score. Secondary outcome indicators: (1) adverse reactions; (2) recurrence rate of follow-up. Results: a total of 32 studies were included. Meta-analysis showed that the total effective rate of cervical spondylosis was improved: 1. Gegen decoction (addition and subtraction) has advantages over simple oral non-steroidal anti-inflammatory drugs, (2) simple Gegen decoction (addition and subtraction) has advantages over simple oral Chinese patent medicine (non-Puergen decoction or its addition and subtraction), (3) Gegen decoction (addition and subtraction) combined with acupuncture has advantages over simple acupuncture; (4) Gegen decoction (addition and subtraction) combined with traction has advantages over simple traction, and (5) Gegen decoction (addition and subtraction) combined with massage has advantages over simple massage. Gegen decoction (addition and subtraction) combined with massage has advantages over oral western medicine (celecoxib capsule) combined with massage. Qualitative analysis showed that Gegen decoction could reduce the VAS score of cervical spondylosis pain. No adverse reactions were found in all the literature. There are many literatures on the treatment of nerve root type, followed by cervical type and vertebral artery type, and other types of cervical spondylosis are not mentioned alone. Conclusion: Gegen decoction can improve the effective rate of patients with cervical spondylosis and reduce the VAS score of cervical spondylosis pain. No adverse reactions were found. And it has obvious effect on nerve root type, cervical type and vertebral artery type of cervical spondylosis.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9
[Abstract]:Background: cervical spondylosis is a disease caused by cervical disc degeneration and cervical degeneration, such as neck, shoulder and upper limb pain and dysfunction, headache, vertigo and so on. It can be divided into cervical type, nerve root type, vertebral artery type, spinal cord type, sympathetic nerve type and mixed type. When each type of cervical spondylosis is serious, there will be symptoms such as pain and numbness of neck and shoulder, vertigo, nausea and so on, while cervical Spondylotic myelopathy will lead to lower extremity muscle strength decline, severe paralysis, seriously affecting the quality of life of patients. Traditional Chinese medicine decoction has long been mentioned in the ancient books of traditional Chinese medicine for the treatment of neck discomfort, and the provisions of Pugen decoction recorded in the Treatise on febrile Diseases mentioned "Sun disease, Xiang back strong, no sweat evil wind, Pugen decoction." Among them, "Xiang back strength several" and cervical spondylosis symptoms are very similar. At present, many literatures have studied the clinical randomized trials of Gegen decoction and its addition and subtraction in the treatment of cervical spondylosis, but there is no systematic evaluation and Meta analysis of Gegen decoction and its addition and subtraction in the treatment of cervical spondylosis. In this study, Gegen decoction and its addition and subtraction in the treatment of cervical spondylosis were systematically evaluated and analyzed by Meta, so as to evaluate the effectiveness and safety of Gegen decoction with scientific and credible methods, and to explore the clinical value of Gegen decoction. In order to provide high-level evidence-based medical evidence for clinical practice and related scientific research, evidence-based medicine (EBM) is used to provide evidence-based medicine (EBM) for clinical practice and related scientific research. Objective: to evaluate the efficacy and safety of Gegen decoction and its addition and subtraction in the treatment of cervical spondylosis by systematic evaluation and Meta analysis. Evidence-based medicine (EBM) is used to provide high-level evidence-based medical evidence for clinical practice and related scientific research. Methods: the Chinese biomedical literature database (CBM), Wanfang database, PubMed database and Cochrane Library database were searched by computer. The time ends in 2016. All Gegen decoction and its addition and subtraction were included in the randomized controlled trial of cervical spondylosis. Meta analysis of the included literature was carried out by using RevMan5.3 software. The advantage ratio (odds ratio,OR) was used for counting data, and the mean difference (mean difference,MD) was used as effect evaluation for continuous variable data, and 95% confidence interval (confidence interval,CI) was provided to represent the results. When the clinical heterogeneity of the trial results is within the acceptable range, quantitative analysis is carried out, and considering the complexity of traditional Chinese medicine treatment, the random effect model is selected. If the heterogeneity of the test results is large, the qualitative analysis is used. The main outcome indexes were (1) total efficiency and (2) VAS score. Secondary outcome indicators: (1) adverse reactions; (2) recurrence rate of follow-up. Results: a total of 32 studies were included. Meta-analysis showed that the total effective rate of cervical spondylosis was improved: 1. Gegen decoction (addition and subtraction) has advantages over simple oral non-steroidal anti-inflammatory drugs, (2) simple Gegen decoction (addition and subtraction) has advantages over simple oral Chinese patent medicine (non-Puergen decoction or its addition and subtraction), (3) Gegen decoction (addition and subtraction) combined with acupuncture has advantages over simple acupuncture; (4) Gegen decoction (addition and subtraction) combined with traction has advantages over simple traction, and (5) Gegen decoction (addition and subtraction) combined with massage has advantages over simple massage. Gegen decoction (addition and subtraction) combined with massage has advantages over oral western medicine (celecoxib capsule) combined with massage. Qualitative analysis showed that Gegen decoction could reduce the VAS score of cervical spondylosis pain. No adverse reactions were found in all the literature. There are many literatures on the treatment of nerve root type, followed by cervical type and vertebral artery type, and other types of cervical spondylosis are not mentioned alone. Conclusion: Gegen decoction can improve the effective rate of patients with cervical spondylosis and reduce the VAS score of cervical spondylosis pain. No adverse reactions were found. And it has obvious effect on nerve root type, cervical type and vertebral artery type of cervical spondylosis.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9
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1 崔昕;葛根汤的疗效[J];国外医学(中医中药分册);1997年01期
2 朱世杰,王泽梅;葛根汤治目{，
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