铺灸疗法为主治疗强直性脊柱炎的Meta分析

Meta Analysis of Primary Treatment for Ankylosing Spondylitis by Long Snake Moxibustion

目的:评价铺灸疗法治疗强直性脊柱炎(Ankylosing Spondylitis,AS)疗效的优越性、远期疗效及安全性。方法:计算机检索从2000年到2012年在中国知网(CNKI)、万方数据库(WF)中收录的有关铺灸疗法为主治疗AS的随机对照试验(randomized controlled trial,RCT)文献,对文献进行质量评价,并用Review Manager 5.1软件进行荟萃分析(Meta分析)。结果:总共纳入临床随机对照试验文献17篇,涉及患者共1 700名。Meta分析结果显示铺灸疗法治疗强直性脊柱炎的总体有效率优于口服西药疗法和单纯针刺疗法。与口服西药疗法比较,合并后效应指标RR=1.24,95%(Confidence Interval,CI)为(1.14,1.35);与针刺疗法比较,合并后效应指标RR=1.27,95%CI(1.05,1.53)。结论:此次纳入研究文献质量普遍偏低:全部为单中心RCT研究,无多中心研究。其次,随机分组方法不够准确,多数文献未描述随访、脱落、远期疗效情况,诊断标准、疗效评价指标种类繁多,未能采取国际公认的标准。与口服西药疗法比较,铺灸疗法的总体有效率远高于口服西药疗法,疗效优越且复发率较低,无毒副作用,安全可靠;和针刺疗法比较,虽然药物铺灸疗法总体有效率较高,由于纳入研究数目较少,总病例数亦少,无远期疗效和安全性方面对比,其结果有待于大样本、多中心、方法科学的高质量临床研究加以验证。

Objective： To evaluate the advantages of long snake moxibustion in treating ankylosing spondylitis （AS）, theraprutic effect and the safety. Method： All the papers about randomized controlled trial of spreading moxi- bustion for AS were searched fi＇om 2000 to 2012 in CNKI and WanFang database, quality estimation was performed and all the papers were analyzed with Review Manager 5.1 software. Result： There were 17 pieces included, involv- ing 1 700 patients. Meta analysis results indicated that total effective rate of spreading moxibustion in treating AS was superior to that of oral Western medicine and acupuncture therapy. Compared with oral Western medicine, merged effective indexe RR=1.24, 95%, （Confidence Interval, CI） was（1.14, 1.35）; compared with the acupuncture therapy, merged effective indexe RR=l.27, 95%CI（1.05, 1.53）. Conclusion： First of all, the included literature was in low quality and lacked multi-centered study. Next, randomized grouping method was inaccurate, the descriptions of follow-ups, drop and long-term effects weren＇t found in most of the papers, there were many indexes judging diag- nostic standard and clinical efficacy but short of the standard. Total effective rate of spreading moxibustion was higher than that of oral Western medicine, the therapy, safe and reliable, could obtain better effects, with low recur- rence rate and minor adverse reactions; although total effective rate of drug spreading moxibustion was higher, with a small number of samplings, less medical cases and lack of the comparisons in long-term effects and the safety, the results were needed to be verified by high quality RCT.