中医药治疗纤维肌痛综合征的网状Meta分析

Network Meta-analysis of Different Interventions of Traditional Chinese Medicine for Treating Fibromyalgia Syndrome

目的:通过网状Meta分析的方法评价中医药不同干预措施治疗纤维肌痛综合征的临床疗效,得出最优的推荐方案。方法:计算机检索中国知网数据库(CNKI)、维普数据库(VIP)、万方数据库、中国生物医学文献数据库(CBM)、Pub Med、Embase、Cochrane Library等数据库,收集并筛选公开发表的中医药治疗本病相关的随机对照试验(RCT)文献;然后,提取纳入文献资料并通过Cochrane Handbook 5.1.0的偏倚评价标准对纳入文献进行偏倚风险评价;最后,运用ADDIS 1.16.8软件对所有低偏倚风险的高质量文献进行网状Meta分析。结果:共纳入文献38篇,涉及干预措施12种,共计病例3143例,其中低偏倚风险的文献有24篇,对此24篇文献进行网状Meta分析结果显示:①在改善VAS疼痛评分方面针刺+推拿为最优推荐方案,其次为中药口服+西药及穴位埋线;②在改善愈显率方面穴位埋线成为最优治疗的概率最高,其次为推拿或针刺联合拔罐及西药治疗;③在改善FIQ评分方面功法+西药治疗可能为最优的干预方案,其次为穴位埋线;④在改善HAMD评分方面针刺+西药是最佳治疗方案。结论:对于所有分析的结局指标,中医药治疗纤维肌痛综合征的临床疗效均优于单纯西药常规治疗,且综合治疗方案一般优于单一治疗方案。但由于纳入文献和目前研究的局限性,研究结论还有待以后更多高质量的临床随机对照试验进一步证实。

Objective:Using the method of network Meta-analysis to evaluate the clinical efficacy of different intervention measures of TCM on treating fibromyalgia syndrome and obtain the optimal recommended regimen.Methods:First,CNKI,VIP,Wanfang Database,Chinese Biomedical Literature Database(CBM),Pub Med,Embase and Cochrane Library were retrieved by computer to collect and screen the documents of the randomized controlled trial(RCT)related to the treatment of traditional Chinese medicine.The literature was extracted and the bias risk assessment was carried out through the bias evaluation standard of Cochrane Handbook 5.1.0.Finally,the ADDIS 1.16.8 software was used to make a network Meta-analysis of all low-risk high-quality literature.Results:A total of 38 articles were included,involving 12 interventions and a total of 3143 cases,there were 24 articles with low bias risk.The results of the network Meta-analysis:①Acupuncture combined with massage was the best recommendation in decreasing VAS pain score,followed by oral Chinese medicine and Western medicine and acupoint catgut embedding.②Acupoint catgut embedding was most probably to become the best treatment in improving the healing rate,followed by massage or acupuncture combined with cupping and Western medicine treatment.③In decreasing the FIQ score,Gong-Fa combined with Western medicine treatment may be the best intervention,followed by acupoint catgut embedding.④In decreasing the HAMD score,acupuncture combined with Western medicine was the best treatment.Conclusion:For all the outcome measures of the analysis,the clinical efficacy of traditional Chinese medicine for treating fibromyalgia syndrome is better than that of Western medicine alone,and the comprehensive treatment is generally superior to the single treatment.However,due to the limitations of the literature and current research,the conclusions has yet to be further confirmed by more high-quality RCTs in the future.