温针灸治疗腰椎间盘突出症系统评价

Systematic Review on Warm Acupuncture Treatment for Lumbar Intervertebral Disc Protrusion

目的对温针灸治疗腰椎间盘突出症(LIDP)相关文献进行Meta分析和试验序贯分析(TSA),系统评价临床疗效,为该病防治提供循证医学依据。方法计算机检索中国知识资源总库(CNKI)、中国学术期刊数据库(万方数据)、中文科技期刊数据库(重庆维普)、中国生物医学文献数据库(CBM)、Pub Med、Cochrane Library、Embase中温针灸治疗LIDP临床随机对照试验相关文献,检索范围均为建库至2017年3月。按照Cochrane系统评价手册5.2.0偏倚风险评估工具对纳入文献进行质量评价,采用Revman5.2软件进行Meta分析,采用TSAv0.9软件进行TSA。结果共纳入文献10篇,总计受试者1035例。Meta分析结果显示:温针灸治疗LIDP在总有效率[95%CI(2.43,5.40),Z=6.31,P<0.000 01]、疼痛指数[95%CI(-1.05,-0.58),Z=6.77,P<0.000 01)、腰椎功能[95%CI(2.56,8.61),Z=3.62,P=0.000 3]方面均优于其他疗法,差异有统计学意义。纳入研究的漏斗图提示存在发表偏倚。TSA结果提示本研究总有效率、疼痛指数Meta分析结果可靠。结论温针灸治疗LIDP疗效明确,有一定优势。但本研究纳入文献质量不高,尚需更多大样本、多中心的临床随机对照试验进一步验证。

Objective To conduct Meta analysis and trial sequential analysis （TSA） on warm acupuncture treatment on lumbar intervertebral disc protrusion （LIDP）; To provide references for evidence-based medicine of this disease. Methods Articles about warm acupuncture treatment for LIDP clinical randomized controlled trials in CNKI, Wanfang database, Chonging Wepu, CBM, OubMed, Cochrane Library, and Emnase were retrieved by computer. The retrieval range was from the database establishing to March, 2017. According to Cochrane Handbook for Systematic Reviews of Interventions 5.2.0 Bias risk assessment tool, included articles were under quality evaluation. Revman5.2 software was used to carry out Meta analysis, and TSAv0.9 software was used to conduct TSA. Results Ten articles were included, involving 1035 cases. Meta analysis showed that the total effective rates of warm acupuncture treatment for LIDP [95%CI （2.43, 5.40）, Z=6.31, P〈0.000 01], pain index [95%CI （-1.05, -0.58）, Z=6.77, P〈0.000 01], lumbar function [95%CI （2.56, 8.61）, Z=3.62, P=0.000 3] were better than other therapies, with statistical significance. Funnels included in the study suggest publication bias. TSA results suggested that the total efficiency and pain index Meta analysis results of this study were reliable. Conclusion Warm acupuncture treatment for LIDP has confirmed efficacy, with certain advantages. However, the literature included is not with good quality, so more large sample, multicenter, methodological RCTs are needed for further validation.