中药、针刺、灸法和推拿等中医疗法治疗血瘀型腰椎间盘突出症的网状Meta分析

Treating lumbar disc herniation of blood stasis type with Chinese herbs,acupuncture,moxibustion,and massage:a Bayesian network Meta-analysis

目的:中药、针刺及推拿等中医疗法在治疗腰椎间盘突出症方面有着不可替代的作用,但是由于其治疗方法的多样性且目前研究多为两两比较,尚缺乏多种措施之间的疗效比较。文章运用网状Meta分析方法评价中医疗法治疗血瘀型腰椎间盘突出症的有效率及疼痛缓解情况。方法:检索中国期刊全文数据库、维普中文科技期刊全文数据库、万方数据期刊论文资源、PubMed、The Cochrane Library英文数据库中有关中医疗法治疗血瘀型腰椎间盘突出症的随机对照试验,检索日期为各数据库建立到2020年2月。由2名研究员根据设定好的标准独立筛选文献、数据提取及质量和风险偏倚评估。应用Stata 14.2软件绘制网状结构图、预测区间图及发表偏倚的比较-校正漏斗图,采用Ge MTC 0.14.3版本软件进行网状Meta分析。结果:①文章共纳入28个随机对照试验,合计2508例腰椎间盘突出症患者,涉及中药、针刺、灸法、推拿、西药、针灸、中药+灸法、推拿+灸法、中药+针刺、针刺+推拿、针刺+推拿+中药11种治疗措施;②根据Cochrane偏倚风险工具评价结果,总结得到纳入的28篇文献中有21篇文章评价为高风险,7篇文章评价为不清楚;③网状Meta分析结果显示:在有效率上,其他治疗措施均优于西药,灸法、针灸、中药+灸法、推拿+灸法、中药+针刺、针刺+推拿、针刺+推拿+中药均优于中药,灸法、针灸、推拿+灸法、中药+针刺均优于针刺,推拿+灸法优于推拿;④目测类比评分上,其他治疗均优于西药,中药+灸法、推拿+灸法、中药+针刺、针刺+推拿+中药优于中药;⑤有效率从优到劣依次为推拿+灸法>中药+灸法>针灸>针刺+推拿+中药>中药+针刺>灸法>针刺+推拿>推拿>针刺>中药>西药;⑥目测类比评分从优到劣依次为推拿+灸法>针刺+推拿+中药>中药+灸法>中药+针刺>针灸>针刺+推拿>灸法>推拿>针刺>中药>西药。结论:根据现有的研究证据显示,推拿+灸法优于其他10种干预措施且从中看出联合疗法多优于单独疗法,故确切的结果仍需要大量的随机对照试验来证明。

OBJECTIVE:Traditional Chinese medicine(TCM),acupuncture,and massage have irreplaceable effects in the treatment of lumbar disc herniation.Currently,although pairwise comparisons are mostly conducted due to the diversity of treatment measures,there is still a lack of comparing the therapeutic efficacy among various measures.In this study,we conducted a Bayesian network Meta-analysis to evaluate the therapeutic efficacy of TCM therapies in patients with lumbar disc herniation of blood stasis type as well as pain relief after treatment.METHODS:CNKI,VIP,WanFang,PubMed,and the Cochrane Library were searched for randomized controlled trials regarding TCM treatment of blood stasis type lumbar disc herniation.The retrieval date was from inception until February 2020.Two researchers independently selected literature,extracted data and evaluated quality and risk deviation according to the set criteria.Stata 14.2 was used to draw a network structure chart,prediction interval chart and comparison-correction funnel chart of publication bias.Ge MTC version 0.14.3 was used to carry out a network Meta-analysis.RESULTS:In total,28 randomized controlled trials were included in this study,with a total of 2508 patients with lumbar disc herniation.These trials involved 11 treatment measures,including TCM,acupuncture,moxibustion,massage,western medicine,acupuncture and moxibustion,TCM+moxibustion,massage+moxibustion,TCM+acupuncture,acupuncture+massage,acupuncture+massage+TCM.According to the results of Cochrane’s biased risk tool evaluation,21 of the 28 articles included were evaluated as high risk,and 7 articles were evaluated as unclear.The results of network meta-analysis showed that:in terms of efficiency,other treatment measures are superior to western medicine,moxibustion,acupuncture,TCM+moxibustion,massage+moxibustion,TCM+acupuncture,acupuncture+massage,acupuncture+massage+TCM are superior to traditional Chinese medicine,moxibustion,acupuncture,massage+moxibustion,TCM+acupuncture are superior to acupuncture,and massage+moxibustion is superior to massage.In terms of Visual Analogue Scale score,other treatments are better than western medicine,TCM+moxibustion,massage+moxibustion,TCM+acupuncture,acupuncture+massage+TCM are better than TCM.Efficiency in descending order is as follows:massage+moxibustion>TCM+moxibustion>acupuncture>acupuncture+massage+TCM>TCM+acupuncture>moxibustion>acupuncture+massage>massage>acupuncture>TCM>western medicine.The score of Visual Analogue Scale from the best to the worst is as follows:massage+moxibustion>acupuncture+massage+TCM>TCM+moxibustion>TCM+acupuncture>acupuncture>acupuncture+massage>moxibustion>massage>acupuncture>TCM>western medicine.CONCLUSION:Existing evidence indicates massage+moxibustion is superior to the other 10 kinds of interventions;therefore,the combination therapy is mostly superior to the single therapy.Exact results should certainly be confirmed by a large amount of randomized controlled trials.