中医外治法防控儿童青少年轻、中度近视进展的Meta分析

Meta-analysis of Traditional Chinese Medicine external treatment for preventing and controlling the progression of mild to moderate myopia in children and adolescents

目的 系统评价中医外治法防控儿童青少年轻、中度近视进展的临床疗效。方法 检索2012年1月—2022年4月PubMed、Embase、Cochrane Library、中国知网、万方、维普、中国生物医学文献数据库中关于中医外治法防控儿童青少年轻、中度近视的随机对照试验(RCT),由2位研究者独立筛选文献。评价纳入研究的偏倚风险后,采用RevMan 5.4统计软件进行Meta分析。结果 共纳入13篇文献,1,595例(3,093只眼)6~18岁患者,其中试验组1,540只眼,对照组1,553只眼。使用中医外治法防控儿童青少年轻、中度近视发展的试验组总体有效率优于阿托品滴眼液组[OR=5.160,95%CI(3.770,7.060),Z=10.250,P=0.000]和(复方)托吡卡胺滴眼液组[OR=4.320,95%CI(3.060,6.100),Z=8.310,P=0.000],在提高患者的裸眼视力[MD=0.070,95%CI(0.050,0.090),Z=6.230,P=0.000]、控制屈光度进展[MD=0.360,95%CI(0.290,0.440),Z=9.100,P=0.000]方面也优于使用抗胆碱能类滴眼液的对照组。结论 中医外治法在一定程度上可延缓儿童青少年轻、中度近视进展,对屈光参数有改善作用,一般无明显不良反应。但纳入文献的研究方法不统一,未来还需多中心、大样本、高质量的RCT进一步验证。

OBJCTIVE To systematically evaluate the clinical efficacy of Traditional Chinese Medicine(TCM) external treatment for preventing and controlling the progression of mild to moderate myopia in children and adolescents.METHODS Randomized controlled trial(RCT) on TCM external treatment for preventing and controlling mild to moderate myopia in children and adolescents were retrieved from PubMed,Embase,Cochrane Library,CNKI,Wanfang,VIP,and CBMdisc from January 2012 to April 2022.There were two researchers independently screened the literature after assessing the risk of bias in the included studies.Meta-analysis was performed using RevMan 5.4 software.RESULTS A total of 13 studies were included,including 1,595 patients(3,093 eyes) aged 6~18 years old,there were 1,540 eyes in the experimental group and 1,553 eyes in the control group.The overall effective rate of TCM external treatment for preventing and controlling the progression of mild to moderate myopia in children and adolescents was superior to that of atropine eye drops [OR=5.160,95%CI(3.770,7.060),Z=10.250,P=0.000] and(compound) tropicamide eye drops [OR=4.320,95%CI(3.060,6.100),Z=8.310,P=0.000].It also showed better outcomes in improving uncorrected visual acuity [MD=0.070,95%CI(0.050,0.090),Z=6.230,P=0.000] and controlling the progression of refractive diopters [MD=0.360,95%CI(0.290,0.440),Z=9.100,P=0.000] compared to the control group using anticholinergic eye drops.CONCLUSIONS TCM external treatment can delay the progression of mild to moderate myopia in children and adolescents to some extent,improve refractive parameters,and generally has no significant adverse reactions.However,the included studies have methodological heterogeneity,and further validation through multicenter,large-sample,highquality RCT is needed in the future.