本文選題：針灸 + 慢性疲勞綜合征�。� 參考：《成都中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：背景：慢性疲勞綜合征(CFS)是臨床常見的疾病之一,發(fā)病率逐年升高,嚴(yán)重影響患者的生活質(zhì)量。針灸治療CFS方法豐富,但由于尚且缺乏高質(zhì)量的研究證據(jù),目前針灸治療CFS的臨床療效尚不明確。此外,其處方選穴特點(diǎn)及配伍規(guī)律還不夠清晰,不利于最佳處方的應(yīng)用和療效的提高。目的：運(yùn)用系統(tǒng)評價和Meta-分析的方法,評價針灸治療CFS的臨床療效和安全性；構(gòu)建CONSORT和STRICTA賦分賦權(quán)方案,詳細(xì)分析針灸治療CFS隨機(jī)對照試驗(yàn)(RCT)的報告質(zhì)量；運(yùn)用數(shù)據(jù)挖掘技術(shù)分析針灸治療CFS的選穴和配伍規(guī)律,為臨床治療及研究提供優(yōu)化證據(jù)。方法：1.系統(tǒng)評價和Meta-分析方法：運(yùn)用Cochrane系統(tǒng)評價方法檢索Pubmed、 Embase、Cochrane library、CBM等數(shù)據(jù)庫,依照納入/排除標(biāo)準(zhǔn)進(jìn)行嚴(yán)格篩選,運(yùn)用Cochrane handbook5.1推薦的偏倚風(fēng)險評估工具對最終納入的文獻(xiàn)進(jìn)行偏倚風(fēng)險評估,運(yùn)用Revman5.2軟件對符合標(biāo)準(zhǔn)的隨機(jī)對照試驗(yàn)(RCTs)結(jié)果進(jìn)行Meta分析,采用GRADE profiler 3.6軟件對基于各結(jié)局指標(biāo)證據(jù)群的質(zhì)量進(jìn)行評級。2.RCT報告質(zhì)量分析方法：基于1996年、2001年、2010年三個版本的CONSORT,以及2001年、2010年兩個版本的STRICTA,擬定各條目的賦分方案和賦權(quán)方案；對針灸治療CFS的RCT進(jìn)行文獻(xiàn)檢索和嚴(yán)格篩選,根據(jù)上述標(biāo)準(zhǔn)對最終納入的文獻(xiàn)逐條賦分、賦權(quán)；采用Microsoft Excel 2007和SPSS 21.0對各條目的加權(quán)得分進(jìn)行統(tǒng)計分析,對針灸治療CFS的RCT報告質(zhì)量進(jìn)行分析。3.數(shù)據(jù)挖掘方法：系統(tǒng)檢索和嚴(yán)格篩選后,建立針灸處方數(shù)據(jù)庫,運(yùn)用“針灸數(shù)據(jù)挖掘系統(tǒng)V1.0”分析處方選穴和配伍規(guī)律。結(jié)果：1.系統(tǒng)評價結(jié)果：①最終納入9篇文獻(xiàn),共730例患者。②毫針刺與安慰針刺對照：Chalder疲勞量表總分[WMD=-8.19,95%CI (-10.62,-5.76)],疲勞嚴(yán)重程度量表評分[WMD=-4.96,95%CI(-11.83,1.91)],SF-36生活質(zhì)量量表總效應(yīng)量[WMD=10.78,95%CI(6.01,15.55)],軀體和心理健康報告評分[WMD=-2.75,95%CI(-5.94,0.44)],VAS疼痛評分[WMD=-34.69,95%CI(-70.89, 1.51)]。③毫針刺與靜脈滴注對照：Chalder疲勞量表總分[WMD=-1.93,95%CI (-2.75,-1.11)]。④電針與安慰電針對照：疲勞嚴(yán)重程度量表評分[WMD=-12.87, 95%CI(-15.86,-9.88)],SF-36生活質(zhì)量量表總效應(yīng)量[WMD=17.15,95%CI (15.54,18.76)],軀體和心理健康報告評分[WMD=-6.94,95%CI(-8.67,-5.21)], VAS疼痛評分[WMD=-11.33,95%CI(-16.56,-6.10)].⑤毫針刺與安慰針刺對照中以Chalder量表、FSS評分、SPHERE量表、SF-36為結(jié)局指標(biāo)的證據(jù)質(zhì)量為中級,以VAS疼痛量表為結(jié)局指標(biāo)的證據(jù)質(zhì)量為低級；毫針刺與靜脈滴注對照中以Chalder量表為結(jié)局指標(biāo)的證據(jù)質(zhì)量為中級；電針與安慰電針對照中以FSS評分、SPHERE量表、SF-36、VAS疼痛量表為結(jié)局指標(biāo)的證據(jù)質(zhì)量為中級。⑥6項(xiàng)研究未提及不良事件發(fā)生情況,3項(xiàng)研究無不良事件。2.RCT報告質(zhì)量評價結(jié)果：最終納入34篇文獻(xiàn),①CONSORT評分結(jié)果：所納入研究報告質(zhì)量總平均分為133.68分(換算成百分制為40.63分),文題和摘要、引言、方法、結(jié)果、討論、其他信息六部分平均分分別為5.38分、5.32分、3.38分、3.69分、5.67分、0.29分；②STRICTA評分結(jié)果：所納入研究報告質(zhì)量總平均分為94.39分(換算成百分之為56.86分),針刺治療的合理性、針刺細(xì)節(jié)、治療方案、輔助干預(yù)措施、治療師的背景、對照或?qū)φ崭深A(yù)六部分平均分分別為5.25分、6.03分、9.12分、3.16分、0.15分、5.88分；③CONSORT和STRICTA分層分析結(jié)果：以“是否為2010年前發(fā)表的論文”和“是否為中文核心期刊收錄論文”為分層因子的分析結(jié)果均顯示差異無統(tǒng)計學(xué)意義(均P0.05),以“是否為學(xué)位論文”和“是否有基金資助”為分層因子的分析結(jié)果均顯示差異有統(tǒng)計學(xué)意義(均P0.05)。3.數(shù)據(jù)挖掘結(jié)果：共納入文獻(xiàn)196篇,針灸處方218條,共使用腧穴43個,使用總頻次1377次；單腧穴使用頻次和支持度前五位是足三里(136/62.4%)、腎俞(92/42.2%)、脾俞(86/39.4%)、肝俞(84/38.5%)、三陰交(78/35.8%)；“足三里+三陰交”在兩穴配伍項(xiàng)集支持度最高,“三陰交→內(nèi)關(guān)”在兩穴配伍項(xiàng)集置信度最高,“足三里+三陰交+百會”在三穴配伍項(xiàng)集支持度和置信度均最高,“足三里+關(guān)元+腎俞+脾俞”在四穴配伍項(xiàng)集支持度和置信度均最高。結(jié)論：1.毫針刺在降低Chalder疲勞量表得分上優(yōu)于安慰針刺和靜脈滴注,在降低FSS得分、SPHERE得分、VAS疼痛得分,提高SF-36得分上優(yōu)于安慰針刺；電針在降低FSS得分、SPHERE得分、VAS疼痛得分,提高SF-36得分上優(yōu)于安慰電針。但其研究結(jié)果的GRADE證據(jù)等級不高,且納入的試驗(yàn)較少,故該研究結(jié)論需謹(jǐn)慎對待。2.今后針灸治療CFS的RCT應(yīng)在隨機(jī)方法及分配隱藏的實(shí)施、樣本量的估算、統(tǒng)計學(xué)方法的運(yùn)用、試驗(yàn)方案的調(diào)整和相關(guān)信息報告、輔助干預(yù)措施、治療師的背景、針刺細(xì)節(jié)等方面加強(qiáng)報告質(zhì)量;CONSORT和STRICTA賦分、賦權(quán)方案的構(gòu)建使針灸干預(yù)的臨床研究的報告質(zhì)量評價內(nèi)容更豐富、結(jié)果更精準(zhǔn),對完善針灸臨床試驗(yàn)設(shè)計和報道的指導(dǎo)性更強(qiáng)。3.針灸治療CFS以辨病取穴為主,多選用足陽明胃經(jīng)、足太陽膀胱經(jīng)和足太陰脾經(jīng)腧穴,重視補(bǔ)益穴和背俞穴的使用；在配伍上以足三里穴與上述諸經(jīng)腧穴配伍為基本配伍,運(yùn)用表里經(jīng)配穴法、交會經(jīng)配穴法和三部配穴法,充分體現(xiàn)了從脾腎入手,重視先后二天的調(diào)理治療CFS的學(xué)術(shù)思想。
[Abstract]:Background: chronic fatigue syndrome (CFS) is one of the common clinical diseases. The incidence of the disease is increasing year by year, which seriously affects the quality of life of the patients. The method of acupuncture and moxibustion for the treatment of CFS is rich, but the clinical efficacy of acupuncture and moxibustion for the treatment of CFS is still unclear because of the lack of high quality evidence. Besides, the characteristics of the selection of the prescription and the compatibility of the prescription are not enough. Clear, not conducive to the application of the best prescription and the improvement of curative effect. Objective: To evaluate the clinical efficacy and safety of acupuncture and moxibustion for the treatment of CFS by means of systematic evaluation and Meta- analysis; to construct the CONSORT and STRICTA assigning empowerment scheme, and to analyze the quality of the report of CFS randomized controlled trial (RCT) in the treatment of acupuncture and moxibustion, and to analyze the application of data mining technology. Acupuncture and moxibustion treatment of CFS in the selection of acupoints and compatibility rules provide optimal evidence for clinical treatment and research. Methods: 1. systematic evaluation and Meta- analysis methods: using Cochrane system evaluation method to retrieve Pubmed, Embase, Cochrane library, CBM and other databases, strictly screening according to the inclusion / exclusion criteria, using Cochrane handbook5.1 recommended deviation. The risk assessment tool was based on the bias risk assessment of the final literature, using the Revman5.2 software to carry out Meta analysis on the results of the standard randomized controlled trial (RCTs), and using GRADE profiler 3.6 software to evaluate the quality of the.2.RCT report based on the quality of the evidence groups based on the outcome indicators: Based on 1996, 2001, 2010. The three versions of CONSORT, as well as the two versions of STRICTA in 2001, and the two version of the 2010, draw up various purposes and empowerment schemes. The literature retrieval and strict screening of the RCT for the acupuncture and moxibustion treatment of CFS are classified and weighted according to the above criteria, and the weight of Microsoft Excel 2007 and SPSS 21 is weighted for each purpose. The score was statistically analyzed, and the quality of the RCT report of CFS was analyzed by.3. data mining methods: after systematic retrieval and strict screening, the database of acupuncture and moxibustion prescription was established and the "acupuncture data mining system V1.0" was used to analyze the rules of prescription selection and compatibility. Results: 1. the results were as follows: (1) the final inclusion of 9 literature, a total of 730 cases Patients. (2) needling needles and consolation needles: Chalder total score [WMD=-8.19,95%CI (-10.62, -5.76)], fatigue severity scale score [WMD=-4.96,95%CI (-11.83,1.91)], SF-36 quality of life scale [WMD=10.78,95%CI (6.01,15.55)), physical and mental health report score [WMD=-2.75,95%CI (-5.94,0.44)], VAS pain Score [WMD=-34.69,95%CI (-70.89, 1.51)]. (3) needle puncture and intravenous drip control: Chalder Fatigue Scale total score [WMD=-1.93,95%CI (-2.75, -1.11)]. (4) electroacupuncture and consolation electroacupuncture: Fatigue Severity Scale score [WMD=-12.87, 95%CI (-15.86, -9.88)], SF-36 quality of life scale total effect [WMD=17.15,95%CI), body The body and mental health report score [WMD=-6.94,95%CI (-8.67, -5.21)], VAS pain score [WMD=-11.33,95%CI (-16.56, -6.10)]. 5. The evidence quality of the FSS score, SPHERE scale, SF-36 as the outcome index is intermediate, and the evidence quality of the VAS pain scale is low; The evidence quality of the Chalder scale as the result of the Chalder scale was intermediate, the quality of the evidence was FSS, the SPHERE scale, the SF-36, and the VAS pain scale were intermediate. 6. No adverse events were mentioned in the 6 studies, and the quality evaluation of the.2.RCT report without adverse events was evaluated in 3 cases. Results: the final inclusion of 34 papers, (1) CONSORT score results: the total quality of the study report was divided into 133.68 points (the conversion rate of 40.63). The article and summary, introduction, method, result, discussion, and other six parts were divided into 5.38, 5.32, 3.38, 3.69, 5.67, 0.29, and the results of STRICTA score were: The total quality of the study was divided into 94.39 points (56.86 points in conversion), the rationality of acupuncture treatment, the details of acupuncture, the treatment scheme, the intervention measures, the background of the therapist, the control or the control intervention in six parts, 5.25 points, 6.03 points, 9.12 points, 3.16, 0.15, 5.88 points; (3) CONSORT and STRICTA stratification points. Analysis results: the analysis results of "whether the papers published before 2010" and "whether the papers included in Chinese Core Journals" as stratified factors showed no statistical difference (all P0.05). The results of semantic (mean P0.05).3. data mining: 196 articles were included, 218 acupuncture prescriptions were used, 43 acupoints were used, and 1377 times were used. The use frequency and support of the single acupoints were Zusanli (136/62.4%), Shenshu (92/42.2%), spleen Yu (86/39.4%), 84/38.5%, 78/35.8%, and "Zusanli + three yin" at the two points. The support degree of the combination item is the highest, and the reliability of the two acupoint compatibility is the highest. The support degree and confidence degree of "Zusanli + three yin" and "Baihui" in the three acupoints are the highest. "Zusanli + Guan yuan + Shenshu + splenic Yu" in the four acupoints support degree and confidence degree are the highest. Conclusion: 1. needle prickles in the reduction of Chalder The fatigue scale was superior to consolation acupuncture and intravenous drip. It was superior to consolation acupuncture in reducing FSS score, SPHERE score, VAS pain score and improving the score of SF-36; Electroacupuncture was superior to consolation electroacupuncture in reducing FSS score, SPHERE score, VAS pain score, and improving SF-36 score, but the results of GRADE evidence were not high, and included in the test. The results of the study are less. Therefore, the conclusion of the study should be carefully treated with.2. in the treatment of CFS's RCT in the future of acupuncture and moxibustion treatment in random methods and distribution, the estimation of the sample size, the use of statistical methods, the adjustment of the test scheme and the related information report, the auxiliary intervention measures, the therapist's background, the details of acupuncture, and so on; CONSORT and STRICTA The construction of the empowerment scheme makes the evaluation of the clinical research report of acupuncture and moxibustion more accurate, more accurate, more guidance for improving the design and reporting of clinical trials of acupuncture and moxibustion,.3. acupuncture and moxibustion treatment CFS to identify the main points of the disease, choose Foot Yangming stomach meridian, foot sun bladder meridian, foot Taiyin spleen meridian acupoint, pay attention to tonifying point and The use of the back Shu point; the compatibility of the Zusanli point with the acupoints of the acupoints in the compatibility of the combination of the acupoints of the Zusanli and the method of acupoints with the acupoint with the meridian, the intersection of the meridians and the three points with the acupoint method, which fully embodies the academic thought of the treatment of CFS from the spleen and kidney for two days.
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R246.1

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