Tension-type headache（TTH） is the most prevalent type of primary headache. Many studies have shown that the pathogenesis of primary headache is associated with fine structural or functional changes. However, these s...Tension-type headache（TTH） is the most prevalent type of primary headache. Many studies have shown that the pathogenesis of primary headache is associated with fine structural or functional changes. However, these studies were mainly based on migraine. The present study aimed to investigate whether TTH patients show functional disturbances compared with healthy subjects. We used restingstate functional magnetic resonance imaging（f MRI） and regional homogeneity（Re Ho） analysis to identify changes in the local synchronization of spontaneous activity in patients with TTH. Ten patients with TTH and 10 age-, gender-, and education-matched healthy controls participated in the study. After demographic and clinical characteristics were acquired, a 3.0-T MRI system was used to obtain restingstate f MRIs. Compared with healthy controls, the TTH group exhibited significantly lower Re Ho values in the bilateral caudate nucleus, the precuneus, the putamen, the left middle frontal gyrus, and the superior frontal gyrus. There was no correlation between mean Re Ho values in TTH patients and duration of TTH, number of attacks, duration of daily attacks, Visual Analogue Scale score, or Headache Impact Test-6 score. These results suggest that TTHpatients exhibit reduced synchronization of neuronal activity in multiple regions involved in the integration and processing of pain signals.展开更多
目的系统评价针灸治疗紧张性头痛(tension-type headache,TTH)的临床疗效及纳入证据质量,为临床决策提供循证依据。方法通过检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、PubMed、Web of Science等数据库查找针灸治疗TTH的随机对照...目的系统评价针灸治疗紧张性头痛(tension-type headache,TTH)的临床疗效及纳入证据质量,为临床决策提供循证依据。方法通过检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、PubMed、Web of Science等数据库查找针灸治疗TTH的随机对照试验相关文献,检索时间从数据库建库至2021年11月25日。运用Cochrane偏倚风险评估工具对纳入研究进行偏倚风险分析,采用Review Manager 5.3软件对纳入研究的总有效率、头痛程度视觉模拟量表(VAS)评分、头痛发作频次、头痛持续时间、头痛指数进行Meta分析。并参考GRADE标准对证据质量进行评价。结果共纳入14项随机对照试验(RCT),①Meta分析结果显示:针灸组(或针灸联合西药组)总有效率高于西药组,差异有统计学意义[OR=1.22,95%CI(1.15,1.28),Z=7.17,P<0.00001];针灸组(或针灸联合西药组)在改善患者头痛程度[OR=-1.27,95%CI(-1.58,-0.96),Z=8.01,P<0.00001]、降低患者头痛发作频次[OR=-0.97,95%CI(-1.32,-0.62),Z=5.37,P<0.00001]、降低患者头痛持续时间[OR=-0.45,95%CI(-0.72,-0.17),Z=3.19,P=0.001]、降低头痛指数[OR=-8.78,95%CI(-10.32,-7.24),Z=6.06,P<0.00001]方面均优于西药组,且差异均有统计学意义。②GRADE结果显示:纳入证据质量在总有效率、头痛发作频次、头痛程度(VAS评分)、头痛持续时间方面为低级;头痛指数为极低级。结论针刺是治疗紧张型头痛的有效方法,在提高总有效率,降低患者头痛程度、持续时间及发作频次方面均优于西药组。但研究证据质量总体较低,在未来临床研究设计中应更加严谨规范,为针灸治疗TTH的临床疗效提供更可靠的证据。展开更多
目的:系统收集中药治疗紧张性头痛(TTH)临床研究的现有证据,评价中药治疗紧张性头痛临床研究的现状。方法:计算机检索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)...目的:系统收集中药治疗紧张性头痛(TTH)临床研究的现有证据,评价中药治疗紧张性头痛临床研究的现状。方法:计算机检索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)、EMbase、PubMed、Cochrane Library、Web of science、ClinicalTrials.gov和中国临床试验注册中心共10个数据库,检索时限为建库至2020年10月,纳入有关中药治疗TTH的临床研究,采用证据图方法呈现临床研究的证据分布情况。结果:共纳入471项临床研究,其中随机对照试验378项,非随机对照试验41项,队列研究1项,病例系列研究51项,文献总发表数量在总体上随时间变化呈增长趋势,但呈“锯齿状”波动;方法学质量评价结果显示目前中药治疗紧张性头痛的临床研究质量较低;中药治疗紧张性头痛对总有效率、安全性事件、头痛持续时间、头痛强度、头痛发作频率、焦虑抑郁量表关注度较高,对经济学指标及远期预后指标关注较低。疗程集中在15~30 d。结论:目前中药治疗TTH的临床研究质量较低,未来需要开展更多高质量的临床研究为中药治疗TTH提供更充分的证据。展开更多
基金supported by the National Natural Science Foundation of China (81071140)
文摘Tension-type headache（TTH） is the most prevalent type of primary headache. Many studies have shown that the pathogenesis of primary headache is associated with fine structural or functional changes. However, these studies were mainly based on migraine. The present study aimed to investigate whether TTH patients show functional disturbances compared with healthy subjects. We used restingstate functional magnetic resonance imaging（f MRI） and regional homogeneity（Re Ho） analysis to identify changes in the local synchronization of spontaneous activity in patients with TTH. Ten patients with TTH and 10 age-, gender-, and education-matched healthy controls participated in the study. After demographic and clinical characteristics were acquired, a 3.0-T MRI system was used to obtain restingstate f MRIs. Compared with healthy controls, the TTH group exhibited significantly lower Re Ho values in the bilateral caudate nucleus, the precuneus, the putamen, the left middle frontal gyrus, and the superior frontal gyrus. There was no correlation between mean Re Ho values in TTH patients and duration of TTH, number of attacks, duration of daily attacks, Visual Analogue Scale score, or Headache Impact Test-6 score. These results suggest that TTHpatients exhibit reduced synchronization of neuronal activity in multiple regions involved in the integration and processing of pain signals.
文摘目的:系统收集中药治疗紧张性头痛(TTH)临床研究的现有证据,评价中药治疗紧张性头痛临床研究的现状。方法:计算机检索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)、EMbase、PubMed、Cochrane Library、Web of science、ClinicalTrials.gov和中国临床试验注册中心共10个数据库,检索时限为建库至2020年10月,纳入有关中药治疗TTH的临床研究,采用证据图方法呈现临床研究的证据分布情况。结果:共纳入471项临床研究,其中随机对照试验378项,非随机对照试验41项,队列研究1项,病例系列研究51项,文献总发表数量在总体上随时间变化呈增长趋势,但呈“锯齿状”波动;方法学质量评价结果显示目前中药治疗紧张性头痛的临床研究质量较低;中药治疗紧张性头痛对总有效率、安全性事件、头痛持续时间、头痛强度、头痛发作频率、焦虑抑郁量表关注度较高,对经济学指标及远期预后指标关注较低。疗程集中在15~30 d。结论:目前中药治疗TTH的临床研究质量较低,未来需要开展更多高质量的临床研究为中药治疗TTH提供更充分的证据。
