黄芪桂枝五物汤治疗神经根型颈椎病的系统评价

Systematic Evaluation of Huangqi Guizhi Wuwutang(黄芪桂枝五物汤) in the Treatment of Cervical Spondylotic Radiculopathy

目的:系统评价黄芪桂枝五物汤治疗神经根型颈椎病的疗效与安全性。方法:检索中国知网、万方、维普、Cochrane Library、PubMed、EMbase等数据库自收录以来至2017年10月发表的黄芪桂枝五物汤治疗神经根型颈椎病的随机对照试验,并用Cochrane协作网提供的Review Manager 5.3软件对纳入的文献进行Meta分析。结果:最终纳入10个研究,共889例患者。对10个研究进行合并分析:黄芪桂枝五物汤组总有效率较常规西药组有优势(RR=1.23,95%CI=[1.14,1.33],Z=5.38,P<0.000 01);视觉模拟评分法(VAS)评分与西药组比较,差异有统计学意义(MD=-1.24,95%CI=[-1.52,-0.96],Z=8.63,P<0.000 01);黄芪桂枝五物汤联合推拿组总有效率较推拿组更优(RR=1.13,95%CI=[1.03,1.24],Z=2.49,P=0.01);黄芪桂枝五物汤联合推拿组VAS评分较推拿组降低,疼痛症状改善(MD=-1.19,95%CI=[-1.73,-0.66],Z=4.37,P<0.000 1)。结论:现有的证据表明,黄芪桂枝五物汤能改善神经根型颈椎病症状,降低VAS评分;但纳入研究数量偏少且质量偏低,尚需要更多高质量文献来确定其疗效。

Objective:To evaluate the efficacy and safety of Huangqi Guizhi Wuwutang(黄芪桂枝五物汤)in the treatment of cervical spondylotic radiculopathy.Methods:A retrieval was made for randomized controlled trials of Huangqi Guizhi Wuwutang in the treatment of cervical spondylotic radiculopathy which have been included in CNKI,Wanfang,VIP,Cochrane Library,PubMed and EMbase since October,2017,and the software Manager 5.3 provided by Cochrane was used to make a meta-analysis for them.Results:A total of 10 studies(889 cases)were finally included in the study.The total effective rate of in the Huangqi Guizhi Wuwutang group had an advantage over the conventional western medicine group(RR = 1.23,95%CI = [1.14,1.33],Z = 5.38,P < 0.00001)and there was a statistical significance of VAS score between them(MD =-1.24,95%CI =[-1.52,-0.96],Z = 8.63,P < 0.000 01).The total curative effect of the group treated with Huangqi Guizhi Wuwutang combined with massage group was better than the massage group(RR = 1.13,95%CI = [1.03,1.24],Z = 2.49,P = 0.01),while its VAS score was lower than the massage group(MD =-1.19,95%CI = [-1.73,-0.66],Z = 4.37,P < 0.0001),with its pain symptoms reduced.Conclusion:The existing evidence indicates that Huangqi Guizhi Wuwutang can improve the symptoms of cervical spondylotic radiculopathy and reduce the VAS score.Since the quantity of the research is limited and the quality is relatively low,more high-quality literature is needed to confirm its curative effect.