本文選題：針灸 + 慢性咽炎��； 參考：《成都中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：檢索2016年1月前針灸方法治療慢性咽炎(排除急性咽炎)的臨床隨機(jī)對(duì)照試驗(yàn)(Randomized Controlled Trials, RCT),納入針灸或針灸聯(lián)合藥物與藥物治療慢性咽炎來對(duì)照的RCT研究,通過系統(tǒng)評(píng)價(jià)對(duì)針灸改善慢性咽炎臨床癥狀的療效采取評(píng)價(jià),分析臨床取穴規(guī)律,為針灸治療慢性咽炎的臨床運(yùn)用提供循證醫(yī)學(xué)依據(jù)。方法：文獻(xiàn)檢索：檢索國(guó)內(nèi)外數(shù)據(jù)庫(kù)：①中文數(shù)據(jù)庫(kù)：計(jì)算機(jī)檢索中國(guó)知網(wǎng)(1995-2016)、維普數(shù)據(jù)庫(kù)(1995-2016)、萬方數(shù)字化期刊(2016年1月1日以前)以及中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(1995-2016)；②英文數(shù)據(jù)庫(kù)：The Cochrane Library (2016), PubMed (1995-2016); EMBASE (1995-2016);③手工檢索本校圖書館相關(guān)資料；④ http://scholar.google.com等網(wǎng)絡(luò)資料、灰色文獻(xiàn)數(shù)據(jù)庫(kù)和會(huì)議文獻(xiàn)數(shù)據(jù)庫(kù)(CMCC)上進(jìn)行補(bǔ)充檢索。確定文獻(xiàn)：由兩名系統(tǒng)評(píng)價(jià)員按照本系統(tǒng)評(píng)價(jià)的診斷、納入及排除標(biāo)準(zhǔn),對(duì)資料進(jìn)行提取,選出所有針灸或者針灸聯(lián)合藥物治療慢性咽炎的臨床隨機(jī)對(duì)照實(shí)驗(yàn),如遇到問題存在分歧,通過討論或由其他方仲裁解決。數(shù)據(jù)分析：對(duì)納入的文獻(xiàn)依據(jù)評(píng)價(jià)員手冊(cè)(5.1.0)和GRADE證據(jù)等級(jí)進(jìn)行文獻(xiàn)質(zhì)量評(píng)價(jià),再通過Cochrane協(xié)作網(wǎng)專用統(tǒng)計(jì)軟件包(Review Manager 5.3.5),進(jìn)行定性和meta分析。結(jié)果：(1)總共納入21篇符合標(biāo)準(zhǔn)的文獻(xiàn),其總樣本量為2200例受試者,試驗(yàn)組1145例,對(duì)照組1055例。按照干預(yù)措施分組,針灸與藥物對(duì)照12篇,針灸結(jié)合基礎(chǔ)治療與基礎(chǔ)治療對(duì)照9篇；(2)主要結(jié)局指標(biāo)總有效率分析,針灸與藥物對(duì)照組RR=1.29,95%CI[1.22,1.36],針灸結(jié)合基礎(chǔ)治療與基礎(chǔ)治療對(duì)照組RR=1.18,95%CI[1.11,1.25];治愈率分析,針灸與藥物對(duì)照組RR=1.97,95%CI[1.66,2.34],針灸結(jié)合基礎(chǔ)治療與基礎(chǔ)治療對(duì)照組RR=1.51,95%CI[1.27,1.81];(3)對(duì)針灸治療慢性咽炎后血管內(nèi)皮細(xì)胞黏附分子(VCAM-1)及血清IL-2、TNF-a進(jìn)行定性分析。結(jié)論：(1)基礎(chǔ)治療的前提下,增加針灸療法能提高臨床總有效率及治愈率,改善癥狀與體征,證據(jù)等級(jí)為中級(jí),給予推薦；(2)針灸療法比西藥更能提高慢性咽炎的總有效率及治愈率,證據(jù)等級(jí)為中級(jí),給予推薦；(3)基礎(chǔ)治療前提下,加用針灸療法可以改善咽喉部癥狀量表評(píng)分,但量表不夠規(guī)范,證據(jù)等級(jí)不高,有待進(jìn)一步研究改善；(4)針灸療法在改善慢性咽炎血管內(nèi)皮細(xì)胞黏附分子(VCAM-1)及血清IL-2、TNF-a比藥物療法更有優(yōu)勢(shì),證據(jù)等級(jí)均為低級(jí)或者極低級(jí),其臨床可靠性不能評(píng)估,只能為臨床提供參考,有待以后對(duì)此深入研究；(5)由于缺乏不良反應(yīng)數(shù)據(jù),無法對(duì)針灸治療慢性咽炎安全性作出客觀評(píng)價(jià)。
[Abstract]:Objective: to retrieve randomized Controlled trials (RCTs) of acupuncture and moxibustion therapy for chronic pharyngitis (excluding acute pharyngitis) before January 2016, and to include the RCT study of acupuncture and moxibustion combined with drugs and drugs in the treatment of chronic pharyngitis. The clinical effect of acupuncture and moxibustion on improving the clinical symptoms of chronic pharyngitis was evaluated through systematic evaluation, and the rule of acupoint collection was analyzed to provide evidence based medicine basis for the clinical application of acupuncture and moxibustion in the treatment of chronic pharyngitis. Methods: literature retrieval: retrieval of domestic and foreign databases: 1 Chinese database: computer retrieval of China Zhiwang (1995-2016), Weipu (1995-2016), Wanfang digital journals (before January 1, 2016) and Chinese biomedical literature database (1995-2016); (2) English database: the Cochrane Library / 2016, PubMed / 1995 / 2016; EMBASE / 1995 / 2016 / 3; 4 http://scholar.google.com and other network data, gray document database and conference document database were used for supplementary retrieval. To confirm the literature: according to the diagnosis, inclusion and exclusion criteria of the system, two systematic evaluators were selected to select all clinical randomized controlled trials of acupuncture and moxibustion combined with drugs for the treatment of chronic pharyngitis. In the event of any disagreement, the dispute shall be settled by discussion or arbitration by other parties. Data analysis: the literature quality was evaluated on the basis of the evaluator's manual 5.1.0) and the GRADE evidence grade, and then the qualitative and meta analysis was carried out through the special statistical software package of Cochrane cooperation network (Review Manager 5.3.5). Results A total of 21 articles were included. The total sample size was 2200 subjects, 1145 subjects in the trial group and 1055 in the control group. According to the intervention measures, there were 12 articles of acupuncture and drug control, 9 articles of acupuncture combined with basic treatment and 9 pieces of basic treatment. The total effective rate of the main outcome indexes was analyzed. The CI of acupuncture and moxibustion and drug control group was 1.2995 [1.221.36], and that of the control group of acupuncture and moxibustion combined with basic therapy was 1.18995 CI [1.111.25], and the cure rate was analyzed. The quantitative analysis of vascular endothelial cell adhesion molecule (VCAM-1) and serum IL-2TNF-a after chronic pharyngitis treated by acupuncture and moxibustion combined with basic therapy and basic therapy was carried out. Conclusion under the premise of basic treatment, the increase of acupuncture and moxibustion therapy can improve the total clinical effective rate and cure rate, improve the symptoms and signs, and the level of evidence is intermediate. The total effective rate and cure rate of chronic pharyngitis can be improved by acupuncture and moxibustion therapy than western medicine. The evidence grade is intermediate. Under the premise of recommended basic treatment, acupuncture and moxibustion therapy can improve the score of pharynx and larynx symptom scale. However, the scale is not standardized and the evidence level is not high. Further research is needed to improve the Acupuncture therapy in the improvement of vascular endothelial cell adhesion molecule (VCAM-1) and serum IL-2TF-a in chronic pharyngitis. Its clinical reliability can not be evaluated, can only provide a reference for clinical practice, and need to be further studied in the future. (5) due to the lack of adverse reaction data, it is impossible to make an objective evaluation on the safety of acupuncture and moxibustion in the treatment of chronic pharyngitis.
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R246.81

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