针刺治疗腰椎管狭窄症证据图及关联规则分析

Evidence Map and Association Rules Analysis of Acupuncture in Treating Lumbar Spinal Stenosis

目的:全面展示针刺治疗腰椎管狭窄症证据分布及选穴关联分析。方法:1)证据图:检索CBM、PubMed、EMbase、国家知识基础设施数据库(CNKI)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD)自建库至2020年9月的文献。经筛选后采用文字结合证据图分析特征;2)关联分析:运用Microsoft Excel 2017对针灸处方进行数据录入,采用SPSS Modeler 18构造出置信度高的腧穴之间的关联规则。结果:针灸治疗该病的文献数量逐年上升,其质量评价A/B/C 3个等级分布大致均等。临床研究最常为针刺加药物疗法。以腰痛为频次最高主症,干预期及随访期多为2周及1个月。主穴频次前4位依次为:委中、环跳、夹脊穴、肾俞;配穴频次前4位依次为:委中、阳陵泉、昆仑、悬钟;主穴配伍穴组前4位依次为:秩边-环跳、承山-环跳、承山-委中、(承山、委中)-环跳;配穴配伍前4位穴组依次为:悬钟-委中、悬钟-阳陵泉、承山-阳陵泉、秩边-环跳。结论:针刺治疗腰椎管狭窄症逐渐受到临床重视,取穴多以经络辨证为依据,强调远近配穴及辨经加减,对临床有一定借鉴意义。

Objective:To comprehensively demonstrate the evidence map of acupuncture in treating lumbar spinal stenosis and conduct the correlation analysis of acupoint selection.Methods:1)Evidence map:Literatures were collected from Chinese BioMedical Literature Database(CBM),PubMed,EMbase,China National Knowledge Infrastructure(CNKI),China Science Periodical Database(CSPD),and Chinese Citation Database(CCD)from the first day of establishing the database to September 2020.The distribution characteristics of evidence were analyzed by the combination of texts with evidence map after selection.2)Association analysis:Microsoft Excel 2017 was used to enter data for acupuncture prescriptions,and SPSS Modeler 18 was used to construct association rules among the acupoints with high confidence.Results:The number of literatures on acupuncture treatment of diseases was on the rise,and the distribution of the three grades of literature quality evaluation A/B/C was roughly equal.The most common therapy in the experimental group was acupuncture plus drug therapy.Among the main symptoms,the frequency of low back pain was the highest.The intervention period and follow-up period were usually 2 weeks and 1 month.The results of the correlation analysis showed that the four major acupoints with the highest frequency were:Weizhong(BL40),Huantiao(GB30),Jiaji(EX-B2),and Shenshu(BL23).The four adjunct acupoints with the highest frequency were Weizhong(BL40),Yanglingquan(GB34),Kunlun(BL60),and Xuanzhong(GB39).The top four acupoints in the major acupoint compatibility group were Zhibian(BL54)-Huantiao(GB30),Chengshan(BL57)-Huantiao(GB30),Chengshan(BL57)-Weizhong(BL40),(Chengshan,Weizhong)(BL57,BL40)-Huantiao(GB30).The top four acupoints in the adjunct acupoint compatibility group were Xuanzhong(GB39)-Weizhong(BL40),Xuanzhong(GB39)-Yanglingquan(GB34),Chengshan(BL57)-Yanglingquan(GB34),Zhibian(BL54)-Huantiao(GB30).Conclusion:This study shows that acupuncture treatment for lumbar spinal stenosis has gradually received clinical attention.The selection of acupoints is based on the differentiation of meridians and collaterals.The emphasis on the combination of far and near acupoints and the addition and subtraction of meridians has certain clinical significance.