身痛逐瘀汤治疗腰椎间盘突出症的系统评价

Efficacy of Shentong Zhuyu Tang( 身痛逐瘀汤) for treatment of lumbar disc herniation: a systematic review

目的:系统评价身痛逐瘀汤治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效。方法:分别以"腰椎间盘突出""腰椎间盘膨出""腰椎间盘脱出""腰椎间盘移位""腰痛""腰腿痛""LDH"与"身痛逐瘀汤"的布尔逻辑搭配结果作为检索词,运用计算机检索中国知网、万方学术期刊数据库和维普中文期刊数据库2000年1月至2016年3月收录的所有相关文献。筛选文献,提取数据,利用Revman5.1软件进行数据统计分析。结果:共检索出116篇文献,经筛选最终纳入17篇,共涉及1929例患者。所纳入文献质量偏低,仅3篇文献说明采用随机数字表进行分组,2篇文献说明了随访情况和安全性评价结果,所有文献均未描述随机分配方案的隐藏方法、是否采用盲法、样本量估算方法及病例脱落情况,Jadad评分≤2分。纳入的17篇文献均进行了2组间临床疗效有效率的比较,各研究结果之间具有同质性(I^2=0%,P=0.900)。治疗组的有效率高于对照组[Z=8.320,P=0.000;OR=2.300,95%CI(1.89,2.79)]。漏斗图显示试验研究分布在竖线的两边,分布较为均匀,不存在发表偏倚。结论:身痛逐瘀汤单独使用或联合其他疗法均能有效缓解LDH患者的临床症状,疗效优于西药、推拿、牵引等治疗。但由于纳入的文献在方法学上存在不足,该结论尚有一定的局限性,有待于更多的高质量的临床随机对照试验进一步证实。

Objective：To systematically review the clinical curative effect of Shentong Zhuyu Tang（ 身痛逐瘀汤,STJYT） in the treat- ment of lumbar disc herniation （LDH）. Methods ： The Boolean logical combination of lumbar disc herniation, lumbar disc bulging, lumbar disc prolapse,lumbar disc displacement,low back pain,lumbagoleg pain, LDH and STJYT were used as index terms respectively to re- trieve all the literatures included from January 2000 to March 2016 from China national knowledge internet, Wantang Database and Vip Da- tabase of Chinese journal through computer. The literatures were screened and the data were extracted. Statistical analysis was conducted by using Rewnan 5.1 software. Results：One hundred and sixteen literatures were searched out. After screening, 17 literatures （ 1929 patients） were included in the final analysis, however, the quality of these literatures was poor. The random digits table was used for grouping only in 3 literatures, and only 2 literatures showed the results of follow-up and safety evaluation. The included literatures failed to report the method for random allocation concealment, the blind method, method for sample size estimation and information about case drop-out. Tile Jadad scores of included literatures were less than or equal to 2 points. The effective rate of clinical curative effect was compared between the 2 groups in all of the 17 literatures and there was homogeneity within the results of different trials （12 = 0%, P = 0. 900 ）. The ett＇eetive rate of treatment group was higher than that of control group（ Z = 8. 320 ,P = 0. 000 ; OR = 2. 300,95% CI（ 1.89,2.79 ） ）. The synunctrical fmmel plot demonstrated that there was no publication bias. Conclusion：Both STJYT alone and combination of STJ YT with other therapies can ef- fectively relieve the clinical symptoms in patients with LDH, and they surpass western medicine,lumbar nmnipulation and lumbar traction in the clinical curative effect. However, the included literatures have shortcomings in methodology, so our conclusion has some limitations and need to be further verified by more high-quality clinical randomized controlled trials.