灸法治疗顽固性面瘫临床疗效的Meta分析

The meta-analysis of clinical efficacy of the moxibustion for intractable facial paralysis

目的基于循证医学理论,对灸法治疗顽固性面瘫的临床疗效进行系统评价,以期为顽固性面瘫的灸法治疗提供有力的依据。方法计算机检索2017年10月1日以前Pub Med、中国知网、中国生物医学文献数据库、维普和万方数据库等全文数据库,纳入灸法治疗顽固性面瘫的随机和半随机对照试验文章,运用Review Manager5. 3软件对纳入文献的研究方法学进行质量评价及偏倚风险评估,同时对主要结局指标痊愈显效率及次要结局指标House-Brackmann面神经功能评级、随访面瘫后遗症发病率进行Meta分析。结果共纳入11项研究,累计样本量984例。Meta分析结果显示:治疗组的痊愈显效率高于对照组,χ~2=11. 19,P=0. 34,I2=11%<50%,选用固定效应模型,OR=3. 77,95%CI为[2. 66,5. 35],合并效应量检验Z=7. 45,具有统计学意义(P <0. 00001);治疗组改善House-Brackmann面神经功能分级优于对照组,异质性检验χ2=1. 98,P=0. 16,I2=50%,选用固定效应模型,MD=-0. 96,95%CI为[-1. 05,-0. 86],合并效应量检验Z=19. 05,差异有统计学意义(P <0. 00001);治疗组随访面瘫后遗症发病率优于对照组,OR=0. 42,95%CI为[0. 17,1. 03],合并效应量检验Z=1. 89,P=0. 06,差异有统计学意义。结论灸法治疗顽固性面瘫具有更好的疗效,能有效改善House-Brackmann面神经功能分级,降低面瘫后遗症发病率。但鉴于本次研究纳入研究文献较少,质量较低,仍需更多高质量的临床研究加以验证。

Objective To assess the clinical curative effect of moxibustion for intractable facial paralysis with evidence - based medicine method, in order to provide strong evidence for the clinical treatment of intractable facial paralysis. Methods Computer retrieval of full - text database before October 1, 2017, including Cochrane Library, CNKI, CMB, VIP, WANFANG DATA and Puhmed. Meta -analysis was conducted on randomized controlled trials （RCT） or half - randomized controlled trial which met the enrolling requirements. Using Review Manager 5.3 software to evaluate the research methodology of included literatures and bias risk, at the same time to conduct meta - analysis to the main outcome measure （cure rate and obvious effective rate）and secondary outcome measures （House -Brackmann facial nerve function rating and incidence of facial paralysis sequelae）. Results A total number of 11 papers involving 984 patients were included. The result show that the treatment group was more effective than the control group, OR = 3.77, 95% CI was [2.66,5.35 ], the combined effect test Z = 7.45, with statistical significance （P 〈 O. 00001 ） ; Treatment group improved House - Brackmann facial nerve function classification better than that of control group, heterogeneity test x2 = 1.98, P = 0. 16, 12 = 50%, choose fixed effects model, MD = 0.96, 95% CI was [ 1.05, 0.86], the combined effect quantity inspection Z = 19.05, the difference was statistically significant （P 〈 0. 00001 ） ; The incidence of facial paralysis sequelae in the treatment group was better than that in the control group, OR = 0.42, 95% CI was [ 0.17,1.03 ], Z = 1.89, P = 0. 06, difference was statistical significance. Conclusion The effect of moxibustion has better treatment of intractable facial paralysis, which can effectively improve the House - Brackmann grade of facial nerve function and reduce the incidence of facial paralysis sequelae. However, due to the small quantity and low quality of included studies, more high - quality clinical studies are needed to validate the result.