基于倾向评分匹配的针刺治疗颈椎病颈痛临床疗效评价

Evaluation of the clinical effect of acupuncture in treatment of neck pain in cervical spondylosis based on propensity score matching

目的:观察针刺治疗颈椎病颈痛的临床疗效与安全性。方法:将472例颈椎病颈痛患者按意愿及接受针刺治疗情况分为针刺组(221例)与非针刺组(251例),采用倾向评分匹配法控制混杂因素后针刺组与非针刺组各纳入218例。针刺组予针刺大椎、百会、阿是穴及双侧颈夹脊、风池、后溪、申脉等穴,每日1次,5次为一疗程,共治疗3个疗程。非针刺组予口服艾瑞昔布片及甲钴胺片,共治疗2周。分别于治疗前后观察两组患者NorthwickPark颈痛量表(NPQ)评分和简式McGill疼痛量表评分,并评定两组安全性。结果:治疗后,两组患者NPQ评分及简式McGill疼痛量表评分均较治疗前降低(P<0.001),且针刺组NPQ评分及简式McGill疼痛量表评分低于非针刺组(P<0.001)。针刺组不良反应发生率为6.0%(13/218),非针刺组不良反应发生率为10.1%(22/218),两组不良反应发生率比较差异无统计学意义(P>0.05)。结论:针刺可有效改善颈椎病颈痛患者的疼痛程度与综合生活质量,且安全性较好。

Objective To observe the clinical effect and safety of acupuncture in treatment of neck pain due to cervical spondylosis.Methods According to the patients'preference and acceptance for the interventions of neck pain induced by cervical spondylosis,an acupuncture group(221 cases)and a non-acupuncture group(251 cases)were divided.After the control of confounding factors with propensity score matching,218 cases were included in either acupuncture group or non-acupuncture group.In the acupuncture group,acupuncture was applied to Dazhui(GV 14),Baihui(GV 20),ashi points,bilateral neck-Jiaji(EX-B 2),Fengchi(GB 20),Houxi(SI 3),Shenmai(BL 62),etc.The treatment was given once daily,one course of intervention was composed of 5 treatments and 3 courses were included.In the non-acupuncture group,the oral administration of imrecoxib tablets and cobalt tablets was prescribed for 2 weeks.Before and after treatment,the scores of Northwick Park questionnaire(NPQ)and the simplified McGill pain questionnaire(SF-MPQ)were observed,and the safety was assessed in patients of the two groups.Results After treatment completion,the scores of NPQ and SF-MPQ were all reduced when compared with those before treatment in each group(P<0.001),and the scores of NPQ and SF-MPQ in the acupuncture group were lower than those of the non-acupuncture group(P<0.001).The incidence of adverse reactions was 6.0%(13/218)in the acupuncture group and was 10.1%(22/218)in the non-acupuncture group,without statistical significance in comparison(P>0.05).Conclusion Acupuncture is effective and safe in the relief of neck pain and the improvement of comprehensive quality of life in the patients with cervical spondylosis.