中医药疗法防控儿童青少年近视的网状Meta分析

Prevention and Control of Myopia in Children and Adolescents by Chinese Medical Therapies:A Network Meta-analysis

目的:应用网状Meta的方法系统评价临床常用中医药手段防控儿童青少年近视的有效性和安全性,为后续临床应用提供循证依据。方法:以国家知识基础设施数据库(CNKI),中国学术期刊数据库(CSPD),中文科技期刊数据库(CCD),中国生物医学文献数据库(CBM),PubMed,Cochrane Library,Embase 7个数据库为资料来源,检索应用中医药手段防控儿童青少年近视的临床随机对照试验文献。对相关文献进行筛选、数据提取并进行风险偏倚评估,采用Stata15.0和Review Manager5.4软件进行数据分析并绘制相关图形。结果:共纳入28篇文献,纳入患者3 017例,涉及9种中医药治疗措施。其中针刺+熏蒸,针刺,耳穴,耳穴+推拿以及口服中药的治疗方法在有效率方面优于常规西医治疗。在调节视力和屈光度方面,耳穴疗法效果优于针刺治疗,且二者疗效均优于常规西医治疗。纳入的研究中有9项提到安全指标,其中仅3项研究出现不良反应,观察组不良反应发生率显著低于对照组。结论:防控儿童青少年近视的中医药疗法多种多样且安全性较高,综合2种及以上手法的效果更为显著,建议临床实践中结合中医辨证及临床实际情况合理选择。

Objective:To systematically evaluate the effectiveness and safety of commonly used Chinese medical therapies for preventing and controlling myopia in children and adolescents using a network Meta-analysis and provide evidence-based guidance for subsequent clinical applications.Methods:Seven databases,i.e.,China National Knowledge Infrastructure(CNKI),China Science Periodical Database(CSPD),Chinese Sci-tech Journal Database(CCD),China Biomedical Literature Database(CBM),PubMed,Cochrane Library,and Embase,were searched for literature on clinical randomized controlled trials(RCTs) on Chinese medical therapies for preventing and controlling myopia in children and adolescents.Relevant literature was screened,followed by data extraction,and assessment of risks of bias.Data were analyzed and related graphics were plotted using Stata 15.0 and Review Manager 5.4 software.Results:A total of 28 articles were included,involving 3 017 patients and nine Chinese medical therapies.Among these therapies,acupuncture combined with fumigation,acupuncture,auricular acupoint therapy,auricular acupoint therapy combined with massage,and oral Chinese medicine were more effective than conventional Western medicine in terms of efficiency.In terms of improving vision and refractive status,auricular acupoint therapy was more effective than acupuncture,and both were superior to conventional Western medicine.Nine studies mentioned safety indicators,with adverse reactions reported in only three studies.The incidence of adverse reactions in the observation group was significantly lower than that in the control group.Conclusion:There are various Chinese medical therapies for preventing and controlling myopia in children and adolescents,with high safety profiles.Combining two or more therapies yields more significant results.It is recommended that clinical practice should integrate syndrome differentiation in traditional Chinese medicine(TCM) and the actual clinical situation for reasonable selection.