灸法治疗颈椎病颈痛的网状Meta分析

Network Meta-Analysis of Moxibustion in Treating Neck Pain of Cervical Spondylosis

目的:系统评价4种临床常用灸法治疗颈椎病颈痛的疗效。方法:全面检索温和灸、麦粒灸、热敏灸、精灸治疗颈椎病颈痛的随机对照试验(randomized controlled trials,RCTs),检索时间为数据库收录期刊起始时间到2018年8月1日。采用Cochrane协作网的RCT偏倚风险评价工具对纳入研究进行方法学质量评估,运用ADDIS1.16.8对纳入研究进行网状Meta分析。结果:纳入8个RCTs,共633例患者。网状Meta分析结果显示:精灸[OR=17.49,95%CI(1.76,285.25)]和热敏灸[OR=3.86,95%CI(1.77,13.75)]的总有效率高于温和灸,精灸总有效率优于麦粒灸[OR=11.58,95%CI(1.24,121.30)]。在NorthwickPark颈痛量表(NPQ)、简式McGill疼痛量表(MPQ)和视觉模拟评分(VAS)方面,4种灸法两两比较,差异无统计学意义。概率排序结果显示,精灸在提高临床总有效率和改善VAS评分方面成为最佳治疗措施可能性最大,而热敏灸在改善NPQ和MPQ评分方面成为最佳干预措施可能性最大。结论:与温和灸和麦粒灸比较,热敏灸和精灸在治疗颈椎病颈痛方面具有一定优势。

Objective:To systematically evaluate the efficacy of four kinds of moxibustion in the treatment of neck pain of cervical spondylosis.Methods:We performed a systematic search for all randomized controlled trials of four kinds of moxibustion in the treatment of neck pain of cervical spondylosis from the establish years of databases to August 1th 2018.Researchers selected articles in accordance with the inclusion and exclusion criteria.The methodological quality of included research was evaluated by bias risk assessment tool of Cochrane collaboration.The network meta-analysis of included RCTs was made by ADDIS 1.16.8.Results:Totally eight RCTs were included and 633 patients involved.The network meta-analysis results showed that both the elaborate moxibustion [OR=17.49,95%CI (1.76,285.25)] and the heat sensitive moxibustion [OR=3.86,95%CI(1.77, 13.75)] were superior to the mild moxibustion with significant statistical differences in total effectiveness;The elaborate moxibustion was also better than moxa cone moxibustion in total effectiveness [OR=11.58,95%CI(1.24, 121.30)].There was no significant differences identified in the NPQ,MPQ and VAS scale among the four kinds of moxibustion.Furthermore,in rank probability,the elaborate moxibustion was the most likely optimal moxibustion in improving total effectiveness and VAS scale,while the sensitive moxibustion was the most likely optimal moxibustion in ameliorating NPQ and MPQ scale.Conclusion:Both the elaborate moxibustion and the heat sensitive moxibustion have advantages for the treatment of neck pain of cervical spondylosis when compared with the mild moxibustion and the moxa cone moxibustion.