中医药治疗儿童腺样体肥大临床研究证据图分析

Analysis on the Evidence Mapping of Clinical Research on TCM Treatment for Childhood Adenoidal Hypertrophy

目的 分析总结中医药治疗儿童腺样体肥大(AH)的临床依据。方法 计算机检索中国知识资源总库(CNKI)、PubMed建库至2022年12月31日中医药治疗儿童AH的原创性研究及系统综述/Meta分析。经过筛选后,以文本与证据图相结合的方式对证据特征进行分析,并使用AMSTAR-2评估工具对系统评价的方法学质量进行评估。结果 共纳入文献102篇,中医治疗儿童AH除辨证给予中药汤剂口服外,还包括针灸、推拿、扁桃体啄治/烙治、中药雾化滴鼻等中医特色疗法及联合疗法。现有临床研究大多倾向于以西医常规疗法(80.2%)作为试验的对照措施,更注重临床症状体征、中医证候积分和腺样体影像检查的结局指标,对伴发疾病、血清炎症指标、过敏反应和远期预后的关注较少。AMSTAR-2量表评价结果表明,现有系统评价/Meta分析的证据质量处于中、低等质量,在方法上存在信息不准确、缺乏偏倚分析等问题。结论 中医药治疗儿童AH方法多样,但相关研究仍存在研究设计不合理、不规范,方法学及研究证据质量整体偏低的问题。

Objective To analyze and summarize the clinical evidence related to the TCM treatment of adenoid hypertrophy(AH) in children.Methods Original research and systematic evaluation/Meta-analysis related to TCM treatment for AH in children were retrieved from CNKI and PubMed database from the establishment of the databases to 31~(st),Dec.2022.After screening,the evidence features were analyzed by combining text and evidence mapping.AMSTAR-2 evaluation tool was used to evaluate the quality of the system evaluation methodology.Results A total of 102 articles were included.In addition to oral administration of TCM decoction based on syndrome differentiation,TCM treatment of AH in children also includes acupuncture and moxibustion,massage,tonsil pecking/cauterization,TCM atomization nose drops and other TCM characteristic therapies and combination therapies.Existing clinical research tends to use conventional Western medicine therapy(80.2%) as a control measure for the experiment,with more attention to clinical symptoms and signs,TCM syndrome scores,and adenoid imaging examination outcome indicators.However,research must focus more on concomitant diseases,serum inflammatory indicators,allergies,and long-term prognosis.According to the AMSTAR-2 scale evaluation,the results showed that the quality of evidence in the existing system evaluation/Meta-analysis was at a medium to low level,and there were methodological issues such as inaccurate information and insufficient bias analysis.Conclusion There are various ways to treat AH in children with TCM.However,there are still issues with unreasonable and non-standard research designs,low methodology,and overall low quality of research evidence in related studies.