中医定向透药治疗腰椎间盘突出症临床疗效的Meta分析

Meta-analysis on the Clinical Efficacy of Dir ectional Chinese Medicine Penetration on Lumbar Disc Herniation

目的:系统评价和分析中医定向透药治疗腰椎间盘突出症的临床应用疗效。方法:采用计算机检索中、英文数据库,并手工翻检湖南省中医药研究院附属医院图书馆学术期刊,搜集自建库至2020年5月有关中医定向透药干预腰椎间盘突出症的临床随机对照研究,筛选符合要求的相关文献并进行数据提取,Meta分析、漏斗图采用RevMan 5.3软件进行。结果:纳入6篇RCT文献,其中试验组275例,对照组268例。Meta分析:临床疗效总有效率[RR=1.16,95%CI(1.08,1.25),Z=4.01,P<0.0001],有统计学差异;VAS评分[MD=-1.30,95%CI(-1.87,-0.73),Z=4.50,P<0.00001],有统计学差异;JOA评分[MD=6.77,95%CI(6.07,7.46),Z=19.03,P<0.00001],有统计学差异;Barthel指数[MD=12.36,95%CI(6.52,18.20),Z=4.15,P<0.00001],有统计学差异;6项研究均未报道不良反应及复发率;漏斗图提示纳入文献可能存在发表偏倚。结论:中医定向透药治疗腰椎间盘突出症具有一定疗效,可减轻患者疼痛症状,加快腰椎功能恢复,提高日常生活能力水平。透药成分以活血化瘀、抗炎止痛、散寒除湿功效为主,后期仍需更多样本量、高质量的临床随机对照试验进一步验证。

Objective:To systematically evaluate and analyze the clinical efficacy of Chinese medicine directed drug penetration in the treatment of lumbar disc herniation.Methods:The Chinese and English databases were searched by computer,and the academic journals of the Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine were manually checked,and the self-built database was collected until May 2020.Clinical randomized controlled studies on the intervention of directional drug penetration of Chinese medicine on lumbar intervertebral disc herniation,Screen the relevant documents that meet the requirements and extract the data.Meta analysis and funnel chart are carried out using RevMan 5.3 software.Results:Six RCT articles were included,including 275 cases in the experimental group and 268 cases in the control group.Meta analysis:the total effective rate of clinical efficacy[RR=1.16,95%CI(1.08,1.25),Z=4.01,P<0.0001],there is a statistical difference;VAS score[MD=-1.30,95%CI(-1.87),-0.73),Z=4.50,P<0.00001],statistically significant;JOA score[MD=6.77,95%CI(6.07,7.46),Z=19.03,P<0.00001],statistically significant;Barthel Index[MD=12.36,95%CI(6.52,18.20),Z=4.15,P<0.00001],statistically different;none of the 6 studies reported adverse reactions and recurrence rates;the funnel chart suggests that there may be publication bias in the included literature.Conclusion:The directional drug penetration of traditional Chinese medicine has a certain effect on the treatment of lumbar intervertebral disc herniation,which can alleviate the patient’s pain symptoms,ac-celerate the recovery of lumbar spine function,and improve the level of daily living.The main components of the transmembrane are activating blood circulation,removing blood stasis,anti-inflammatory and relieving pain,dispelling cold and dehumidifying.In the later stage,more samples and high-quality clinical randomized controlled trials are needed for further verification.