本文選題：四妙散 + 中藥外敷��； 參考：《遼寧中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:對(duì)四妙散加減口服配合中藥外敷治療痛風(fēng)性關(guān)節(jié)炎的多項(xiàng)獨(dú)立研究進(jìn)行meta分析,通過(guò)探討其臨床療效、不良反應(yīng)及對(duì)CRP、ESR、WBC、血尿酸的影響,為痛風(fēng)性關(guān)節(jié)炎的臨床治療及及研究提供循證證據(jù)。資料與方法:確定納入排除標(biāo)準(zhǔn),制定檢索式,全面檢索CNKI中國(guó)知網(wǎng)、萬(wàn)方數(shù)據(jù)、維普中文科技期刊數(shù)據(jù)庫(kù)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)CBM、Pub Med、The Cochrane Library數(shù)據(jù)庫(kù)。檢索年限為建庫(kù)至2016年12月。由兩名評(píng)價(jià)員按納入排除標(biāo)準(zhǔn)對(duì)四妙散加減口服配合中藥外敷治療痛風(fēng)性關(guān)節(jié)炎的隨機(jī)對(duì)照試驗(yàn)進(jìn)行初篩、對(duì)文獻(xiàn)質(zhì)量進(jìn)行評(píng)價(jià)并完成數(shù)據(jù)提取。使用Revman 5.3軟件對(duì)數(shù)據(jù)進(jìn)行meta分析。結(jié)果:共納入18篇隨機(jī)對(duì)照試驗(yàn),共治療1335名患者。試驗(yàn)組均使用四妙散加減口服配合中藥外敷,對(duì)照組均使用西藥,其中5篇單用秋水仙堿,7篇單用NSAIDs,3篇合用秋水仙堿及NSAIDs,3篇急性期使用秋水仙堿,緩解期使用別嘌呤醇。1.共18篇文獻(xiàn)提及總有效率,meta分析結(jié)果顯示:RR=1.16,95%CI[1.08,1.23],Z=4.43(P0.01)2.共14篇提及以血尿酸為觀察指標(biāo),meta分析示:SMD=-1.97,95%CI[-2.66,-1.28],Z=5.59(P0.01)3.共9篇提及以ESR為觀察指標(biāo),meta分析顯示:SMD=-0.82,95%CI[-1.23,-0.41],Z=3.96(P0.01)4.共7篇提及以CRP為觀察指標(biāo),meta分析示:SMD=-0.31,95%CI[-0.69,0.06],Z=1.63(P=0.10)5.共2篇提及以WBC為觀察指標(biāo),meta分析示:SMD=-0.73,95%CI[-0.95,-0.51],Z=6.60(P0.01)6.共11篇文獻(xiàn)提及不良反應(yīng),meta分析示:RR=0.08,95%CI[0.04,0.14],Z=8.47(P0.01)。結(jié)論:1.四妙散加減口服配合中藥外敷治療痛風(fēng)性關(guān)節(jié)炎的總有效率優(yōu)于單純應(yīng)用西藥。2.四妙散加減口服配合中藥外敷可有效降低痛風(fēng)性關(guān)節(jié)炎患者的血尿酸、ESR、WBC。3.不能說(shuō)明四妙散加減口服配合中藥外敷對(duì)于降低痛風(fēng)性患者的CRP的作用優(yōu)于單純應(yīng)用西藥。4.四妙散加減口服配合中藥外敷不良反應(yīng)發(fā)生少于單純應(yīng)用西藥,值得推廣使用。
[Abstract]:Objective: to investigate the clinical efficacy, adverse reactions and effects of SIMAO San plus or subtractive oral administration combined with external application of traditional Chinese medicine on gouty arthritis by meta analysis, and to investigate the effects of the two methods on the treatment of gouty arthritis, including the clinical efficacy, adverse reactions and the effects on the serum uric acid (uric acid) in patients with gouty arthritis. To provide evidence-based evidence for the clinical treatment and research of gouty arthritis. Materials and methods: the criteria of inclusion and exclusion were determined, the retrieval form was formulated, the CNKI China knowledge Network, the Wanfang data, the Weipu Chinese Science and Technology Journal Database, the Chinese Biomedical Literature Database CBM Pub Medbin and the Cochrane Library database were searched in an all-round way. The retrieval period is to build the database until December 2016. According to the exclusion criteria, two evaluators conducted a randomized controlled trial on the treatment of gouty arthritis with the addition and subtraction of Simiao San and external application of traditional Chinese medicine. The literature quality was evaluated and the data were extracted. The data were analyzed by meta using Revman 5.3 software. Results: a total of 1335 patients were treated in 18 randomized controlled trials. All the experimental groups were treated with Simiao powder plus or minus oral administration combined with external application of traditional Chinese medicine, while the control group were all treated with western medicine. Among them, 5 were treated with colchicine alone, 7 with NSAIDsL and 3 with colchicine and NSAIDs3 with colchicine in acute phase, and allopurinol with allopurinol. 1 in remission period. A total of 18 articles mentioned the total effective rate. The results of meta analysis showed that 1: RRN 1.16 and 95 CI [1.08 / 1.23] ZH4. 43 / P0. 01 / 2. A total of 14 articles mentioned that the blood uric acid was used as an index of observation. The analysis of meta showed that: SMD-1.9795 CI [-2.66 ~ (-1.28)] ~ (-5.59) (P _ (0.01)) ~ (3). A total of 9 references were made using ESR as an index of observation. The results of meta analysis showed that: SMD-0.82C95 [-1.23 + -0.41] [-1.23 -0.41] ZH3.96 (P0.01). A total of 7 references were made using CRP as an index of observation. The analysis of meta showed that: SMD-0.31 / 95: CI [-0.69 ~ 0.06] Z 1.63 ~ 0.10 ~ (5). A total of 2 articles mentioned that the WBC was used as the observation index. The analysis of meta showed that: SMD-0.7395 (CI = -0.95U -0.51). A meta analysis of adverse reactions mentioned in 11 articles showed that 1% RRV 0.0895 CI [0.04 0. 14] was 8.47% P0.01C. Conclusion 1. The total effective rate of addition and subtraction of Simiao Powder combined with external application of traditional Chinese medicine in the treatment of gouty arthritis was better than that of western medicine alone. The addition and subtraction of Simiao Powder combined with external application of traditional Chinese medicine can effectively reduce the blood uric acid in patients with gouty arthritis. It can not be explained that the effect of addition and subtraction of Simiao Powder combined with external application of traditional Chinese medicine on reducing CRP in patients with gouty is better than that of western medicine alone. 4. Addition and subtraction of Simiao Powder combined with external application of traditional Chinese medicine have less adverse reactions than western medicine alone, so it is worth popularizing.
【學(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R259

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