臭氧与胶原酶治疗腰椎间盘突出症的荟萃分析

A meta-analysis of the effectiveness of ozone and collagenase treatments for herniated lumbar discs

目的比较臭氧与胶原酶治疗腰椎间盘突出症(LDH)的治疗效果,为临床合理选择治疗方式提供循证医学依据。方法计算机检索PubMed、CENTRAL、EMbase、the ISI Web of KnowledgeDatabases、VIP、CNKI、CBM和万方数据库,查找所有比较臭氧和胶原酶治疗LDH的随机(RCT)或半随机对照试验(CCT),检索时限均为建库至2012年5月31日,同时手检纳入文献的参考文献。按纳入排除标准由2名医师独立进行文献的筛选、资料提取和质量评价后,采用STATA11.0软件进行荟萃分析。结果共纳入8个研究,897例患者。荟萃分析结果显示:①臭氧对胶原酶的有效率:相对危险度(RR)=1.03,95%CI(0.90,1.18),差异无统计学意义(P=0.684);②臭氧对胶原酶优良率:RR=1.02,95%CI(0.91,1.15),P=0.694,差异无统计学意义;③臭氧对胶原酶VAS评分:MD=0.08,95%CI(-0.47,0.63),差异无统计学意义(P=0.783)。基于系统评价结果,采用GRADE系统推荐分级方法评价证据质量及推荐等级,结果显示,证据水平均为低级,推荐强度为弱推荐。结论现有证据提示,对于LDH的治疗,臭氧与胶原酶具有相似的治疗效果。

Objective To compare the clinical efficacy of ozone with that of collagenase in treating lumbar disc herniation （LDH） with the help of meta analysis in order to provide evidence-based foundation for reasonably selecting proper therapy in clinical practice. Methods Databases, including PubMed, Cochrane Central Register of Controlled Trials （CENTRAL）, EMbase, the ISI Web of Knowledge databases, VIP, CNKI, CBM and Wanfang database, started from their establishment to May 31, 2012, were retrieved from computer system for collecting the randomized controlled trials （RCTs） concerning this study, and all the references of those RCTs were also searched for by hand. After study selection, assessment and data extraction conducted by two reviewers independently, meta- analyses were performed by using Stata 11.0 software. The level of evidence was assessed by using GRADE system. Results Eight of 1 395 retrieved articles were brought into this study, with a total of 897 patients. The meta- analyses made the following results. （1） The effective rate of ozone vs. collagenase was RR = 1.03, 95%CI （0.90, 1.18）, the differencewas not statistically significant （P = 0.684）. （2） The good rate of ozone vs. collagenase was RR = 1.02, 95%CI （0.91, 1.15）, the difference was not statistically significant （P = 0.694）. （3） The VAS of ozone vs. collagenase was MD = 0.08, 95%CI （-0.47, 0.63）, the difference was not statistically significant （P =0.783）. Based on GRADE system, all the evidences were classified to level C and fell into weak recommendation category （2C）. Conclusion The current evidence indicates that ozone has the similar thera- peutic effect as collagenase does in treating lumbar disc herniation.（J Intervent Radiol, 2012, 21： 040-045）