活血化瘀类中药注射剂辅助治疗腰椎间盘突出症的网状Meta分析

Network Meta-analysis of Herb Injections Promoting Blood Circulationinadjuvant Treatment of Lumbar Disc Herniation

目的采用网状Meta分析的方法探讨活血化瘀中药注射剂辅助治疗腰椎间盘突出症的疗效,为临床用药提供循证参考。方法查询PubMed、Cochrane Library、万方、维普(VIP)、知网(CNKI),并人工检索相关会议、杂志,收集有关活血化瘀中药注射剂辅助治疗腰椎间盘突出症的随机对照试验或半随机对照试验,检索时间为建库至2019年10月,采用Stata 14.0软件绘制网状证据图,GeMTC 0.14.3软件进行网状Meta分析。结果最终纳入11个RCT、9个半随机对照试验,共计2010例患者,涉及5种中药注射液,分别为香丹注射液、丹参注射液、复方当归注射液、丹红注射液、红花注射液。网状Meta分析结果显示:香丹注射液[OR=14.04,95%CI(5.32,44.24)]、红花注射液[OR=4.14,95%CI(1.97,9.09)]、复方当归注射液[OR=5.35,95%CI(1.51,22.85)]与对照组相比均可提高总有效率,其他两两比较差异无统计学意义,香丹注射液在提高总有效率方面排序最高;香丹注射液[MD=-1.57,95%CI(-2.16,-0.98)]、红花注射液[MD=-1.61,95%CI(-2.15,-1.05)]、复方当归注射液[MD=-1.45,95%CI(-2.63,-0.36)]、丹红注射液[MD=-0.90,95%CI(-1.77,-0.05)]与对照组相比均可降低VAS评分,其他两两比较差异无统计学意义,红花注射液降低VAS评分方面排序最高;丹红注射液[MD=5.57,95%CI(2.18,9.18)]与对照组相比均可降低VAS评分,其他两两比较无统计学差异,其中丹红注射液在提高JOA评分方面排序最高。结论现有证据表明,活血化瘀中药注射剂辅助治疗腰椎间盘突出症时,香丹注射液在提高总有效率方面效果最佳,红花注射液的止痛效果最好,丹红注射液在恢复脊柱功能方面疗效最高。但受纳入文献数量和质量的限制,仍需更多高质量的多中心、大样本的RCT予以证实。

Objective To explore the curative effect of herb injections promoting blood circulation in adjuvant treatment of lumbar disc herniation by means of network Meta analysis,so as to provide evidence-based reference for clinical medication.Methods PubMed,Cochrane Library,Wanfang,VIP,CNKI were inquired,and relevant meetings and magazines were searched manually,and collect randomized controlled trials or semi randomized controlled trials on the treatment of lumbar disc herniation with herb injections promoting blood circulation of promoting blood circulation and removing stasis.The retrieval time is from the establishment of the database to October 2019,Using Stata 14.0 to draw the network evidence map,and gemtc 0.14.3 to conduct the network Meta analysis.Results 11 RCTs and 9 semi randomized controlled trials were included.The results of network Meta analysis showed that:Compared with the control group,Xiangdan injection(香丹注射液)[or=14.04,95%CI(5.32,44.24)],Honghua injection(红花注射液)[or=4.14,95%CI(1.97,9.09)],compound angelica injection(复方当归注射液)[or=5.35,95%CI(1.51,22.85)]can improve the total effective rate.There is no statistical difference between the other two groups.Xiangdan injection ranks the highest in improving the total effective rate,Compared with the control group,Honghua injection[MD=-1.61,95%CI(-2.15,-1.05)],compound angelica injection[MD=-1.45,95%CI(-2.63,-0.36)],Danhong injection(丹红注射液)[MD=-0.90,95%CI(-1.77,-0.05)]can reduce the VAS score,and there is no statistical difference between the other two groups,Honghua injection has the highest ranking in reducing the VAS score;Danhong injection[MD=5.57,95%CI(2.18,9.18)]compared with the control group,VAS score could be reduced,and there was no statistical difference between the other two groups,among which Danhong injection ranked the highest in improving JOA score.Conclusion The existing evidence shows that when herb injections promoting blood circulation are used to assist the treatment of lumbar disc herniation,Xiangdan injection has the best effect in improving the total effective rate,Honghua injection has the best analgesic effect,and Danhong injection has the highest effect in restoring the spinal function.However,due to the limitation of the quantity and quality of the included literature,the conclusion of this study still needs to be confirmed by more high-quality multi center and large sample RCTs.