基于GRADE系統(tǒng)的中藥蒸氣浴治療KOA臨床療效的系統(tǒng)評價
發(fā)布時間：2018-12-06 19:59
【摘要】：目的:系統(tǒng)評價中藥蒸氣浴結(jié)合常規(guī)療法治療膝關(guān)節(jié)骨性關(guān)節(jié)炎的臨床療效。方法:由兩名系統(tǒng)評價員提取檢索關(guān)鍵詞,制定科學(xué)有效的文獻檢索策略,運用計算機檢索中國知網(wǎng)(CNKI)、中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫(CBM)、維普數(shù)據(jù)庫(VIP)、萬方數(shù)字化期刊群(WF)、Pubmed數(shù)據(jù)庫中近5年的文獻;所納入文獻以中藥蒸氣浴或中藥蒸氣浴療法為主結(jié)合其他常規(guī)療法治療KOA為治療組,以對應(yīng)的常規(guī)療法治療KOA為對照組的隨機對照研究,制定納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),納入符合標(biāo)準(zhǔn)的文獻18篇。根據(jù)Cochrane Handbook5.1推薦的偏倚風(fēng)險評估工具,對納入文獻的質(zhì)量進行評價,并運用Revman5.3軟件分析收集到的數(shù)據(jù),亞組分析則是根據(jù)結(jié)合不同的常規(guī)療法分組,共分成4個亞組,分別是:“中藥蒸氣浴”亞組、“中藥蒸氣浴結(jié)合電針”亞組、“中藥蒸氣浴結(jié)合口服美洛昔康+氨基葡萄糖”亞組、“中藥蒸氣浴結(jié)合關(guān)節(jié)腔注射玻璃酸鈉”亞組,結(jié)局評價指標(biāo)采用臨床有效率。制作漏斗圖分析潛在的發(fā)表偏倚。再采用國際上通用的證據(jù)質(zhì)量分級系統(tǒng)GRADE對結(jié)局指標(biāo)的證據(jù)質(zhì)量進行分級。結(jié)果:最終收納18篇文獻,研究共計1761名參與者參加,觀察組患者共計913名,對照組患者共計848名。經(jīng)Meta分析結(jié)果顯示,OR=3.47,95%的CI為[2.53,4.78],其整體效果檢驗Z=7.67,P0.00001。漏斗圖形幾乎是對稱的,說明偏倚風(fēng)險小。亞組分析結(jié)果:“中藥蒸氣浴”亞組:OR=2.44,95%的CI為[1.01,5.93],整體效果檢驗Z=1.98,P0.00001;“中藥蒸氣浴結(jié)合電針”亞組:OR=2.39,95%的CI為[1.36,4.20],整體效果檢驗Z=3.04,P0.00001;“中藥蒸氣浴結(jié)合口服美洛昔康+氨基葡萄糖”亞組:OR=1.65,95%的CI為[0.68,4.02],整體效果檢驗Z=1.10,P=0.27,“中藥蒸氣浴結(jié)合關(guān)節(jié)腔注射玻璃酸鈉”亞組:OR=6.20,95%的CI為[3.69,10.41],整體效果檢驗Z=6.90,P0.00001。GRADE分級結(jié)果:中藥蒸氣浴結(jié)合常規(guī)療法與單純采用常規(guī)療法治療膝關(guān)節(jié)骨性關(guān)節(jié)炎的證據(jù)等級為低級,“中藥蒸氣浴”亞組的證據(jù)等級為極低級,“中藥蒸氣浴結(jié)合電針”亞組的證據(jù)等級為低級,“中藥蒸氣浴結(jié)合口服美洛昔康+氨基葡萄糖”亞組的證據(jù)等級為極低級,“中藥蒸氣浴結(jié)合關(guān)節(jié)腔注射玻璃酸鈉”亞組的證據(jù)等級為低級。結(jié)論:中藥蒸氣浴結(jié)合常規(guī)療法治療膝關(guān)節(jié)骨性關(guān)節(jié)炎的療效優(yōu)于單純采用常規(guī)療法;“中藥蒸氣浴”、“中藥蒸氣浴結(jié)合電針”、“中藥蒸氣浴結(jié)合關(guān)節(jié)腔注射玻璃酸鈉”的療效均優(yōu)于單純采用常規(guī)療法;不能說明“中藥蒸氣浴結(jié)合口服美洛昔康+氨基葡萄糖”的療效優(yōu)于“口服美洛昔康+氨基葡萄糖”;但是系統(tǒng)評價結(jié)果的GRADE分級均為低級和極低級,證據(jù)級別較低,同時需要提供更多大規(guī)模、多中心、高質(zhì)量隨機對照試驗進行論證。
[Abstract]:Objective: to evaluate the clinical effect of steam bath combined with routine therapy on knee osteoarthritis. Methods: the key words were extracted by two system evaluators, and a scientific and effective document retrieval strategy was formulated. (CNKI), Chinese biomedical literature database, (CBM), Weip database (VIP), was searched by computer. The literature in the (WF), Pubmed database of Wanfang Digital Journals Group in recent 5 years; The included literature included traditional Chinese medicine steam bath or traditional Chinese medicine steam bath therapy combined with other conventional therapy for KOA as the treatment group, and the corresponding routine therapy for KOA as the control group as a randomized controlled study, the inclusion criteria and exclusion criteria were established. There were 18 articles which met the standard. According to the bias risk assessment tool recommended by Cochrane Handbook5.1, the quality of the literature was evaluated, and the collected data were analyzed using Revman5.3 software. The subgroup analysis was divided into four subgroups according to the combination of different conventional therapies. They were: "Chinese medicine steam bath" subgroup, "traditional Chinese medicine steam bath combined with electroacupuncture" subgroup, "traditional Chinese medicine steam bath combined with oral meloxicam glucosamine" subgroup, "traditional Chinese medicine steam bath combined with intraarticular injection of sodium hyaluronate" subgroup, and "traditional Chinese medicine steam bath combined with oral meloxicam glucosamine" subgroup, respectively. The outcome was evaluated by clinical efficacy. Make funnel charts to analyze potential publication bias. Then the evidence quality of the outcome index is classified by the international common evidence quality classification system (GRADE). Results: a total of 1761 participants were enrolled in the study, 913 patients in the observation group and 848 patients in the control group. The results of Meta analysis showed that the CI of OR=3.47,95% was [2.53 鹵4.78], and the overall effect of OR=3.47,95% was 7.67% (P 0.00001). Funnel patterns are almost symmetrical, indicating a low risk of bias. The results of subgroup analysis were as follows: the CI of OR=2.44,95% was 1.01 ~ 5.93, and the whole effect test was ZH1.98 (P0.00001). "traditional Chinese medicine steam bath combined with electroacupuncture" subgroup: the CI of OR=2.39,95% was 1.36 ~ 4.20. "Vapor Bath combined with Oral Meloxicam Glucosamine" subgroup: the CI of OR=1.65,95% was [0.68 鹵4.02]. "Vapor Bath of traditional Chinese Medicine combined with Intraarticular injection of Sodium Hyaluronate" subgroup: the CI of OR=6.20,95% was [3.69 ~ 10.41]. The results of P0.00001.GRADE classification showed that the evidence level of traditional Chinese medicine steam bath combined with conventional therapy and simple routine therapy for osteoarthritis of knee joint was lower, and that of "Chinese medicine steam bath" subgroup was extremely low. The evidence level of "traditional Chinese medicine steam bath combined with electroacupuncture" subgroup was lower than that of "traditional Chinese medicine steam bath combined with oral meloxicam glucosamine" subgroup. The evidence level of the "Chinese medicine steam bath combined with intraarticular injection of sodium hyaluronate" was low. Conclusion: the curative effect of steam bath combined with conventional therapy on osteoarthritis of knee joint is better than that of simple routine therapy. The curative effect of "steam bath of Chinese medicine", "steam bath of traditional Chinese medicine combined with electroacupuncture" and "steam bath of traditional Chinese medicine combined with injection of sodium hyaluronate into joint cavity" were better than that of simple conventional therapy. It can not be concluded that "traditional Chinese medicine steam bath combined with oral meloxicam glucosamine" is better than "oral meloxicam glucosamine"; However, the GRADE ratings of the system evaluation results are all low and very low, and the evidence level is lower, and more large scale, multi center, high quality randomized controlled trials are needed to demonstrate.
【學(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R274.9
本文編號：2366575
[Abstract]:Objective: to evaluate the clinical effect of steam bath combined with routine therapy on knee osteoarthritis. Methods: the key words were extracted by two system evaluators, and a scientific and effective document retrieval strategy was formulated. (CNKI), Chinese biomedical literature database, (CBM), Weip database (VIP), was searched by computer. The literature in the (WF), Pubmed database of Wanfang Digital Journals Group in recent 5 years; The included literature included traditional Chinese medicine steam bath or traditional Chinese medicine steam bath therapy combined with other conventional therapy for KOA as the treatment group, and the corresponding routine therapy for KOA as the control group as a randomized controlled study, the inclusion criteria and exclusion criteria were established. There were 18 articles which met the standard. According to the bias risk assessment tool recommended by Cochrane Handbook5.1, the quality of the literature was evaluated, and the collected data were analyzed using Revman5.3 software. The subgroup analysis was divided into four subgroups according to the combination of different conventional therapies. They were: "Chinese medicine steam bath" subgroup, "traditional Chinese medicine steam bath combined with electroacupuncture" subgroup, "traditional Chinese medicine steam bath combined with oral meloxicam glucosamine" subgroup, "traditional Chinese medicine steam bath combined with intraarticular injection of sodium hyaluronate" subgroup, and "traditional Chinese medicine steam bath combined with oral meloxicam glucosamine" subgroup, respectively. The outcome was evaluated by clinical efficacy. Make funnel charts to analyze potential publication bias. Then the evidence quality of the outcome index is classified by the international common evidence quality classification system (GRADE). Results: a total of 1761 participants were enrolled in the study, 913 patients in the observation group and 848 patients in the control group. The results of Meta analysis showed that the CI of OR=3.47,95% was [2.53 鹵4.78], and the overall effect of OR=3.47,95% was 7.67% (P 0.00001). Funnel patterns are almost symmetrical, indicating a low risk of bias. The results of subgroup analysis were as follows: the CI of OR=2.44,95% was 1.01 ~ 5.93, and the whole effect test was ZH1.98 (P0.00001). "traditional Chinese medicine steam bath combined with electroacupuncture" subgroup: the CI of OR=2.39,95% was 1.36 ~ 4.20. "Vapor Bath combined with Oral Meloxicam Glucosamine" subgroup: the CI of OR=1.65,95% was [0.68 鹵4.02]. "Vapor Bath of traditional Chinese Medicine combined with Intraarticular injection of Sodium Hyaluronate" subgroup: the CI of OR=6.20,95% was [3.69 ~ 10.41]. The results of P0.00001.GRADE classification showed that the evidence level of traditional Chinese medicine steam bath combined with conventional therapy and simple routine therapy for osteoarthritis of knee joint was lower, and that of "Chinese medicine steam bath" subgroup was extremely low. The evidence level of "traditional Chinese medicine steam bath combined with electroacupuncture" subgroup was lower than that of "traditional Chinese medicine steam bath combined with oral meloxicam glucosamine" subgroup. The evidence level of the "Chinese medicine steam bath combined with intraarticular injection of sodium hyaluronate" was low. Conclusion: the curative effect of steam bath combined with conventional therapy on osteoarthritis of knee joint is better than that of simple routine therapy. The curative effect of "steam bath of Chinese medicine", "steam bath of traditional Chinese medicine combined with electroacupuncture" and "steam bath of traditional Chinese medicine combined with injection of sodium hyaluronate into joint cavity" were better than that of simple conventional therapy. It can not be concluded that "traditional Chinese medicine steam bath combined with oral meloxicam glucosamine" is better than "oral meloxicam glucosamine"; However, the GRADE ratings of the system evaluation results are all low and very low, and the evidence level is lower, and more large scale, multi center, high quality randomized controlled trials are needed to demonstrate.
【學(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R274.9
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