通窍活血汤治疗偏头痛随机对照试验系统评价

Systematic Evaluation on Randomized Controlled Trials of Tongqiao Huoxue Decoction in Treating Migraine

目的:系统评价通窍活血汤治疗偏头痛的临床疗效及安全性。方法:通过文献检索,搜集通窍活血汤治疗偏头痛的随机对照试验,以通窍活血汤为试验组,西药治疗为对照组,按照Cochrane协作网推荐的方法评估纳入研究的偏倚风险,运用RevMan 5.3软件完成异质性检验、Meta-分析、敏感性分析、倒漏斗图分析等相关统计学分析。结果:共纳入合格研究15项,涉及患者1 367例。Meta-分析结果显示通窍活血汤治疗偏头痛在总有效率、减少不良反应方面与西药比较,具有明显优势,RR=1.36,95%CI[1.28,1.43],结果具有统计学意义(P<0.00001);敏感性分析提示该结果稳定性较好;通窍活血汤在治疗过程中不良反应较少;倒漏斗图分析显示不对称。结论:就现有证据表明,通窍活血汤治疗偏头痛疗效较为突出,且相对西药更为安全,但纳入的文献偏倚风险较高。因此,在随机对照试验的临床应用中,应更加注重方法学的完善,并为临床决策用药提供可靠证据。

Objective：To evaluate the clinical efficacy and safety of Tongqiao Huoxue decoction in treatment of migraine. Methods：Through literature retrieval,randomized controlled trials of Tongqiao Huoxue decoction in the treatment of migraine were colleeted,Tongqiao Huoxue decoction as the experimental group,western medicine as the control group,according to the methods recommended by the Cochrane collaboration to as- sess the risk of bias in the included studies,by using RevMan 5.3 software to finish the heterogeneity test, Meta analysis,sensitivity analysis and funnel analysis. Results：Total 15 eligible studies involved total 1 367 patients. The Meta analysis results showed that the total efficiency and reduction of the adverse reactions of Tongqiao Huoxue decoction in the treatment of migraine had obvious advantages compared to western medicine,RR=1.36, 95% CI [ 1.28,1.43 ] ,P〈0.00001, with statistical significance. The results of sensitivity analysis showed that the stability was good. The adverse reactions of Tongqiao Huoxue decoction reduced and the funnel plot analysis showed asymmetry. Conclusion：The current evidence showed that the curative effects of Tongqiao Huoxue decoction in the treatment of migraine was more prominent and safer than west- ern medicine,but the risk of bias was higher,therefore,in the clinical application of randomized controlled trials ,we should pay more attention to the improvement of methodology and provide the reliable evidence for clinical medication.