杜仲腰痛丸治疗腰椎间盘突出症临床疗效的Meta分析

Meta-analysis of Clinical Efficacy of Duzhong Yaotong Pill on Lumbar Disc Herniation

目的系统评价杜仲腰痛丸治疗腰椎间盘突出症的有效性。方法利用计算机在中国知网数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库(WanFang)、维普数据库(VIP)以及PubMed、Web of Science、Cochrane Library、Embase等数据库检索建库至2022年5月发表的杜仲腰痛丸治疗腰椎间盘突出症的随机对照试验的文献。采用Cochrane协作网偏倚风险工具进行风险评估,改良Jadad量表评分进行文献质量评估,并采用Stata统计软件对改良Jadad评分≥3分的文献进行Meta分析,通过Begg’s检验分析发表偏倚。结果最终检索到8篇符合条件的文献,其中5篇文献Jadad≥3分,共计652例患者;Meta分析结果表明,与其他中、西医保守治疗对照组相比,杜仲腰痛丸联合中、西医治疗可明显改善腰椎间盘突出症(lumbar disc herniation,LDH)患者的主要临床症状有效率[RR=1.11,95%CI(0.97,1.26),P>0.05];此外,疼痛视觉模拟评分(VAS评分)[MD=-0.65,95%CI(-0.93,-0.37),P<0.05]和日本骨科协会评估治疗分数(JOA评分)[RR=0.87,95%CI(0.60,1.13),P<0.05]也均优于对照组。经Begg’s检验表明各研究间无明显的发表偏倚[临床有效率(Z=1.042,P=0.296);VAS评分(Z=0.000,P=1.000);JOA评分(Z=0.000,P=1.000)]。结论现有的证据表明杜仲腰痛丸在治疗腰椎间盘突出症方面具有一定优势,能够有效缓解患者疼痛,显著降低患者VAS评分并提高患者JOA评分,值得临床应用。

Objective The efficacy of Duzhong Yaotong Pill in the treatment of lumbar disc herniation was systematically evaluated.Methods According to the requirements of Meta-analysis,CNKI,CBM,WanFang,VIP,PubMed,Web of Science,Cochrane Library and Embase were searched for literatures on randomized controlled trials of Duzhong Yaotong Pill in the treatment of lumbar disc herniation published from the establishment of databases to May 2022.The Cochrane Collaboration bias risk tool was used for risk assessment,and the modifi ed Jadad scale score was used for literature quality assessment.Review Manager 5.3 statistical software was used for Meta-analysis of literatures with modifi ed Jadad scale score≥3,and publication bias was analyzed by Begg’s test.Results Finally,eight eligible literatures were retrieved,of which five were Jadad≥3,with a total of 652 patients;meta-analysis results showed that compared with other conservative treatment control groups,Duzhong Yaotong pill combined with traditional Chinese and western medicine could significantly improve the eff ective rate of main clinical symptoms in patients with LDH[RR=1.11,95%CI(0.97,1.26),P>0.05];in addition,VAS score(MD=-0.65,95%CI(-0.93,-0.37),P<0.05)and JOA score(RR=0.87,95%CI(0.60,1.13),P<0.05)were signifi cantly better than the control group.Begg’s test showed that there was no signifi cant publication bias between studies[clinical eff ective rate(Z=1.042,P=0.296);VAS score(Z=0.000,P=1.000);JOA score(Z=0.000,P=1.000)].Conclusion The existing evidence shows that Duzhong Yaotong Pill has certain advantages in the treatment of lumbar disc herniation,which can alleviate the pain of patients,signifi cantly reduce the VAS score of patients and improve the JOA score and worthy of clinical application.