独活寄生汤加减联合手法治疗腰椎间盘突出症的系统评价与meta分析

A systematic review and meta-analysis for Duhuo Jisheng decoction combined with manipulation in treatment of lumbar disc herniation

目的系统评价独活寄生汤加减联合手法治疗腰椎间盘突出症的有效性和安全性。方法系统检索了国内外8个数据库,两位研究者独立进行文献检索、筛选、提取数据和对文献质量进行评价,文献质量评估采用Cochrane协作网提供的偏倚风险工具,Meta分析采用RevMan 5.3软件。结果检索共获得427篇文献,最终纳入12项研究1153例患者,均为中文文献。Meta分析结果显示,独活寄生汤加减联合手法治疗腰椎间盘突出症总有效率明显优于对照组RR=1.23,95%CI(1.17,1.29),P<0.00001。亚组分析显示,与常规治疗RR=1.34,95%CI(1.20,1.50),P<0.00001、非甾体类抗炎药RR=1.24,95%CI(1.12,1.37),P<0.0001、腰痛宁胶囊RR=1.19,95%CI(1.10,1.29),P<0.0001治疗相比,独活寄生汤加减联合手法治疗更具显著的效果。在改善VAS评分MD=-1.19,95%CI-1.19(-1.87,-0.51),P=0.0006方面具有较明显的优势,在改善JOA评分MD=2.65,95%CI(0.06,5.24),P=0.05方面无明显优势。安全性研究方面,独活寄生汤加减联合手法治疗报告发生的不良事件较少。结论独活寄生汤加减联合手法治疗能够有效缓解腰椎间盘突出症患者的临床症状,具有明显的临床疗效,且不良事件发生较少。但受限于纳入文献质量偏低的限制,本研究存在一定的局限性,仍需更多高证据质量的研究进一步证实其疗效和安全性。

Objective To systematically evaluate the efficacy and safety of Duhuo Jisheng decoction combined with manipulation in the treatment of lumbar disc herniation.MethodsWe systematically searched 8 databases at home and abroad.Literature quality of the included studies was evaluated by the bias risk assessment tool of Cochrane collaboration network,and the Meta-analysis was performed by RevMan 5.3 software.Results A total of 427 related literatures were retrieved,and 12 studies were eventually included,involving 1153 patients.All studies were in Chinese.Meta-analysis results showed that the total effective rate of Duhuo Jisheng decoction combined with manipulation in the treatment of LDH was better than that of the control groupRR=1.23,95%CI(1.17,1.29),P<0.00001.Subgroup analysis showed that Duhuo Jisheng decoction combined with manipulation had a more significant effect than conventional treatmentRR=1.34,95%CI(1.20,1.50),P<0.00001,nonsteroidal anti-inflammatory drugsRR=1.24,95%CI(1.12,1.37),P<0.0001 and Yaotongning capsulesRR=1.19,95%CI(1.10,1.29),P<0.0001.It has obvious advantages in improving VAS scores MD=-1.19,95%CI-1.19(-1.87,-0.51),P=0.0006,but it has no obvious advantages in improving JOA scoresMD=2.65,95%CI(0.06,5.24),P=0.05.In terms of safety,Duhuo Jisheng decoction combined with manipulation treatment reported fewer adverse events.Conclusion The Duhuo Jisheng decoction combined with manipulation treatment can effectively relieve the clinical symptoms of patients with lumbar disc herniation,with obvious clinical efficacy,and fewer adverse events.But in view of the limitations of clinical studies,there are some limitations in this study,and more studies with high quality of evidence are needed to further confirm its efficacy and safety.