推拿治疗小儿厌食症随机对照试验的系统评价和Meta分析

Systematic Review and Meta-analysis of Randomized Controlled Trials of Tuina in Treatment of Infantile Anorexia

目的:系统评价单纯推拿疗法治疗小儿厌食症的有效性。方法:以"小儿厌食症"、"推拿"、"捏脊"、"infantile anorexia"等为主题词,检索Pub Med数据库、Cochrane图书馆、中国知网数据库、维普中文科技期刊数据库、中国生物医学文献数据库及万方数据库。所有数据库检索时间从建库开始截止至2015年10月10日。由两名评价者独立提取资料,并根据Jadad改良法制定量表进行文献质量评价。采用Cochrane协作网提供的Rev Man5.3软件进行Meta分析。结果:(1)临床总有效率分析:推拿对比中药(RR:1.14;95%CI:1.05,1.24;P=0.002),差异有统计学意义,推拿对比西药(RR:1.42;95%CI:1.31,1.55;P<0.000 01),差异有统计学意义;(2)临床症状总积分改善分析:推拿对比中药(WMD:-3.93;95%CI:-7.91,0.06;P=0.05),差异无统计学意义,推拿对比西药(WMD:-2.00;95%CI:-2.43,-1.56;P<0.000 01),差异有统计学意义。结论:推拿治疗小儿厌食症疗效优于中药及西药,且相对于西药可以明显缓解临床综合症状。但是纳入评价的文献质量偏低,仍需要多中心、大样本的更规范的随机对照试验加以验证。

Objective ： To assess the effectiveness of Tuina in the treatment of infantile anorexia. Methods ： The team used the following keywords： infantile anorexia,Tuina,chiropractic, etc. Literature was searched from PubMed, the Co- chrane Library, the China National Knowledge Infrastructure Database, the VIP Chinese Science and Technology Periodi- cal Database, the Chinese Biomedical Literature Database and Wanfang Database. The time limitation ran from the com- mencement of each database was to October 10, 2015. Two authors collected the data independently. The assessment of methodological quality was based on the Jadad improved method. The data was analyzed by using RevMan 5.3 software for Meta - analysis. Results ： （~Tuina was superior in improving clinical effective percentage to CHM or WM, with statis- tical significance between the groups （ RR ： 1.14 ;95 % CI ： 1.05,1.24 ; P = 0. 002 ）, （ RR ： 1.42 ; 95 % CI ： 1.31,1.55 ; P 〈 0. 000 01 ）. Tuina was superior in reducing the clinical symptom total score （WMD ： - 2.00 ;95% CI ： - 2.43, - 1.56 ;P 〈 0. 000 01 ） but not syperior to the CHM （ WMD ： - 3.93 ; 95% CI ： - 7.91,0.06 ; P = 0. 05 ）. Conclusion ： Tuina ap- pears to improve the clinical effective percentage compared with TCM and WD. Compared with WD, Tuina appears to re- duce the clinical symptom total score of infantile anorexia. However, due to the low quality of included studies, further well designed multicenter and large - scale RCTs are still needed to evaluate the beneficial effects of Tuina.