独活寄生汤治疗腰椎管狭窄症的有效性与安全性Meta分析

The Effectiveness and Safety of Duhuo Jisheng Tang in the Treatment of Lumbar Spinal Stenosis:a Meta Analysis

目的:评价独活寄生汤治疗腰椎管狭窄症(lumbar spinal stenosis,LSS)的有效性与安全性,为临床应用提供循证参考。方法:通过系统检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、EMbase、The Cochrane library数据库有关独活寄生汤加减治疗LSS的国内外临床随机对照试验,检索时间为建库至2021年4月10日,对符合纳入标准的研究文献采用Rev Man 5.3软件进行Meta分析。结果:共纳入符合标准的文献15篇,纳入病例1314例,其中研究组659例,对照组655例;Meta分析结果显示:与对照组相比,研究组有效率(RR=1.19,95%CI:1.09~1.30,P=0.0001)、治疗后视觉模拟量表(visua1 analogue scaleVAS)评分(SMD=-1.03,95%CI:-1.71~-0.36,P=0.003)、日本骨科协会评估治疗分数(Japanese orthopedic association,J0A)评分(SMD-1.46,95%CI:0.72~2.20,P-0.0001)、0swestry功能障碍指数问卷表(0swestry disability index,0DI)评分(SMD=-1.23,95%CI:-1.47~-1.00,P<0.00001)、中医证候评分(SMD=-1.00,95%CI:-1.22~-0.78,P<0.00001)均优于对照组,差异均有统计学意义;两组患者不良反应发生率(RR=0.10,95%CI:0.01~1.70,P=0.11)比较,差异无统计学意义。结论:独活寄生汤加减治疗LSS具有明显优势,能够减轻患者疼痛、改善肢体功能障碍,提高患者生活质量,但安全性方面未体现出明显优势。

Objective:To provide evidence-based reference for clinical application by evaluating the effectiveness and safety of Duhuo Jisheng decoction in the treatment of lumbar spinal stenosis(LSS).Methods:Clinical randomized control trials on the treatment of LSS with modified Duhuo Jisheng Tang were retrieved from CNKI,Wanfang,VIP,CBMdisc,PubMed,EMBASE and the Cochrane library database,the retrieval time ranged from the time of establishing the database to April 10,2021,Meta analysis of the research literature that met the inclusion criteria was carried out using Rev Man 5.3 software.Results:All 15 papers that met the inclusion criteria,and 1314 cases have been included,among them,there were 659 cases in the study group and 655 cases in the control group;Meta analysis result displayed that the effective rate(RR=1.19,95%CI:1.09~1.30,P=0.0001),VAS scores(SMD=-1.03,95%CI:-1.71~-0.36,P=0.003),and JOA scores(SMD=1.46,95%CI:0.72~2.20,P=0.0001),ODI scores(SMD=-1.23,95%CI:-1.47~-1.00,P<0.00001)and TCM syndrome integrals(SMD=-1.00,95%CI:-1.22~-0.78,P<0.00001)were better than these of the control group,and the difference had statistical meaning;compared with the control group,the difference had no statistical meaning in the incidences of adverse reaction(RR=0.10,95%CI:0.01~1.70,P=0.11)between the study group and the control group.Conclusion:Duhuo Jisheng Tang has the clear advantages in the treatment of LSS,it could relieve the patients'pain,improve limb dysfunction and the patients'quality of life,however,there is no clear advantage in terms of safety.