基于贝叶斯学派的中医药疗法治疗功能性肛门直肠痛的网状Meta分析

Network Meta-Analysis of Traditional Chinese Medicine Therapy for Functional Anorectal Pain Based on Bayesian School

目的 运用网状Meta方法分析评价中医药疗法治疗功能性肛门直肠痛各项观察指标疗效,为其临床治疗提供循证医学依据。方法 计算机检索中国知网(CNKI)、维普网(VIP)、万方网(Wangfang)、PubMed、Web of science、Cochrane Library、CBM、Embase等数据库,检索临床应用中医药治疗功能性肛门直肠痛的随机对照实验(Randomized controlled trial,RCT),检索时限为建库至2021年7月。采用Cochrane5.1手册推荐的偏倚风险评估工具对纳入RCT进行质量评价。使用Stata、Winbugs及Revman软件进行数据分析及可视化。结果 最终纳入10项RCT,总样本量725例,共涉及11种干预措施。网状Meta分析结果表明,在总有效率方面,排名前3的干预措施为:止痛如神汤灌肠+长强穴封闭>止痛如神汤口服+外用>当归芍药散口服;在改善VAS评分方面,排名前3的干预措施为:止痛如神汤口服结合外用>止痛如神汤灌肠+长强穴封闭>中药坐浴联合针刺;在改善肛管静息压方面,排名前3的干预措施为:电针八髎穴>中药坐浴联合针刺>穴位注射下髎穴;在改善肛管收缩压方面,排名前3的干预措施为:穴位注射下髎穴>电针八髎穴>中药坐浴联合针刺;在安全性评价方面,排名前3的干预措施为:电针八髎穴>止痛如神汤灌肠+长强穴封闭>止痛如神汤口服+外用。结论 本研究所纳入的RCT中,中医药疗法治疗功能性肛门直肠痛对于各项观察指标的疗效均优于西医疗法,但此结论尚需进一步深入验证。

Objective The net Meta method was used to analyze and evaluate the efficacy of TCM therapy in the treatment of functional anorectal pain, providing evidence-based medical basis for its clinical treatment. Method Databases including CNKI, VIP, Wangfang, PubMed, Web of Science, Cochrane Library, CBM and Embase were searched by computer. The clinical randomized controlled trials(RCTS) of traditional Chinese medicine in the treatment of functional anorectal pain were searched from the database construction to July 2021. The quality of the included studies was evaluated using the bias risk assessment tool recommended in the Cochrane 5.1 manual. Stata, Winbugs and Revman were used for data analysis and visualization. Result Ten RCTS were included, with a total sample size of 725 cases, involving 11 interventions. The results of mesh Meta-analysis showed that in terms of total effectiveness, the top 3 interventions were Zhitongrushen decoction enema+Changqiang acupoint closed>Zhitongrushen decoction orally+externally>Dangguishaoyao pulvis orally;In terms of improving VAS scores, The top 3 interventions were Zhitongrushen decoction orally+externally>Zhitongrushen decoction enema+Changqiang acupoint closed>Chinese medicine sitting bath combined with acupuncture. In improving anal resting pressure, The top 3 interventions were electric acupuncture for Baliao acupoint>Chinese medicine sitting bath combined with acupuncture>point injection for Xialiao point. In improving anal systolic pressure, the top 3 interventions were point injection for Xialiao point>electric acupuncture for Baliao acupoint>Chinese medicine sitting bath combined with acupuncture;In terms of safety evaluation, the top 3 interventions were electric acupuncture for Baliao acupoint>ZHitongrushen decoction enema+CHangqiang acupoint closed>ZHitongrushen decoction orally+externally. Conclusion The curative effect of Traditional Chinese medicine therapy on functional anorectal pain is superior to western medicine therapy for all observed indicators, but this conclusion needs further verification.