本文選題：中西醫(yī)結(jié)合　切入點(diǎn)：Graves眼病　出處：《山東中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:系統(tǒng)評價中西醫(yī)結(jié)合治療Graves眼病的臨床療效。方法:通過計算機(jī)及手工檢索對1986年12月—2016年12月期間國內(nèi)外公開發(fā)表的、采用中西醫(yī)結(jié)合與西藥對照治療Graves眼病的臨床隨機(jī)對照試驗(yàn)的相關(guān)文獻(xiàn)研究進(jìn)行搜集,并按照納入、排除標(biāo)準(zhǔn)選出符合要求的文獻(xiàn)。采用Cochrane協(xié)作網(wǎng)系統(tǒng)評價手冊、運(yùn)用軟件Revman5.3對文獻(xiàn)進(jìn)行系統(tǒng)評價,并運(yùn)用SPSS 23.0進(jìn)行用藥規(guī)律分析。結(jié)果:本研究共篩選出21篇符合納入標(biāo)準(zhǔn)的文獻(xiàn),共計納入研究樣本量1262例,其中試驗(yàn)組665人,對照組597人。分析結(jié)果:總有效率:相對危險度RR值=1.48,95%CI(1.37,1.60),RR合并假設(shè)檢驗(yàn)Z=9.93,P0.00001,說明中西醫(yī)結(jié)合治療Graves眼病總有效率優(yōu)于單純西藥組;甲狀腺功能FT4:SMD=-0.25,95%Cl是(-0.43,-0.07),總體效應(yīng)檢驗(yàn)Z=2.70,P=0.0070.05,表明中西醫(yī)結(jié)合法在改善患者FT4的實(shí)驗(yàn)室指標(biāo)上優(yōu)于西藥組;眼突度分析:SMD=-0.86,95%Cl是(-1.21,-0.50),總體效應(yīng)檢驗(yàn)Z=4.74,P0.00001,表明中西醫(yī)結(jié)合法在改善患者眼突度的指標(biāo)上優(yōu)于西藥組;視力分析:SMD=0.40,95%Cl是(0.10,0.70),總體效應(yīng)檢驗(yàn)Z=2.58,P=0.010.05,表明中西醫(yī)結(jié)合法在改善患者視力上優(yōu)于西藥組;CAS評分:SMD=-1.22,95%Cl是(-2.28,-0.17),總體效應(yīng)檢驗(yàn)Z=2.27,P=0.020.05,即中西醫(yī)結(jié)合法在改善患者CAS評分上優(yōu)于西藥組。安全性分析:比值比OR=0.28,95%CI(0.15,0.55),OR合并假設(shè)檢驗(yàn)Z=3.75,P=0.00020.5,中西醫(yī)結(jié)合組不良反應(yīng)發(fā)生率為10%,西藥組不良反應(yīng)發(fā)生率為24%,即中西醫(yī)結(jié)合組比西藥組在治療Graves眼病過程中安全性更好。結(jié)論:中西醫(yī)結(jié)合法治療Graves眼病在總有效率、FT4及眼突度、視力、CAS評分的改善方面優(yōu)于西藥,且不良反應(yīng)發(fā)生率低,但在FT3及TSH的改善上無明顯差異;由于本研究納入文獻(xiàn)的數(shù)量較少,存在一定局限性,且納入文獻(xiàn)的質(zhì)量評價較低,存在一定的風(fēng)險偏倚,因此還需要進(jìn)一步多中心、大樣本的RCT研究來進(jìn)一步證實(shí)。
[Abstract]:Objective: to evaluate the clinical efficacy of integrated traditional Chinese and western medicine in the treatment of Graves ophthalmopathy. The literature about randomized controlled clinical trials of Graves ophthalmopathy treated by combination of traditional Chinese and western medicine and western medicine were collected and selected according to the inclusion and exclusion criteria. The systematic evaluation manual of Cochrane cooperation network was used. The systematic evaluation of the literature was carried out by software Revman5.3, and the rule of drug use was analyzed by using SPSS 23.0.Results: a total of 21 articles conforming to the inclusion criteria were selected in this study, and 1262 samples were included in the study, among which 665 were in the experimental group. Results: the total effective rate: the relative risk RR value was 1.48% ~ 95% ~ 1.37 ~ 1.60% / RR combined with hypothesis test Zang 9.93% P0.00001, which indicated that the total effective rate of integrated Chinese and western medicine in the treatment of Graves ophthalmopathy was better than that in the western medicine group. The thyroid function FT4: SMD-0.2595 Cl was 0.43% -0.07%. The overall effect test showed that the integrated Chinese and western medicine method was superior to the western medicine group in improving the laboratory index of FT4. The total effect of the total effect test was Zhe 4.74 (P 0.00001), which indicated that the combined Chinese and western medicine was superior to the western medicine group in improving the index of the patients' ophthalmic protrusion. The results showed that the total effect of the combined Chinese medicine and western medicine was better than that of the western medicine group in improving the degree of ophthalmic protrusion. The overall effect test showed that the integrated Chinese and western medicine method was superior to the western medicine group in improving the visual acuity of the patients. The results showed that the score of the Chinese and Western medicine group was better than that of the western medicine group. The overall effect test was Z2.27 P0. 020.05, that is, the combination of traditional Chinese and western medicine was superior to the western medicine group in improving the CAS score of the patients. Safety analysis: the ratio was 0.2895 / 0. 15 / 0.55 / OR combined with hypothesis test. The incidence of adverse reactions was 10 in the integrated Chinese and western medicine group, and 24 in the western medicine group, that is, the safety of the combined Chinese and western medicine group was better than that of the western medicine group in the treatment of Graves ophthalmopathy. Conclusion: the total effective rate of treatment of Graves ophthalmopathy with integrated traditional Chinese and western medicine is FT4 and the degree of ophthalmopathy. The improvement of visual acuity score was better than that of western medicine, and the incidence of adverse reactions was low, but there was no significant difference in the improvement of FT3 and TSH. There is a certain risk bias, so further multicenter, large sample RCT studies are needed to further confirm.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R581;R771.3

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