葛根湯及其加減治療頸椎病的系統(tǒng)評價與Meta分析
發(fā)布時間：2019-05-17 23:55
【摘要】：背景：頸椎病是指由于頸椎間盤退變以及由此導致的頸椎退變,引發(fā)諸如頸肩部及上肢疼痛及功能障礙、頭痛、眩暈等癥狀的一種疾病。一般可分為頸型、神經(jīng)根型、椎動脈型、脊髓型、交感神經(jīng)型及混合型等。各型頸椎病嚴重時會出現(xiàn)諸如頸肩上肢的疼痛麻木、眩暈、惡心等癥狀,而脊髓型頸椎病會導致下肢肌力減退,嚴重時會出現(xiàn)癱瘓,嚴重影響患者的生活質(zhì)量。中藥湯劑治療頸部不適中醫(yī)古籍中早有提及,《傷寒論》中所記載的葛根湯證條文中提到“太陽病,項背強幾幾,無汗惡風,葛根湯主之”。其中的“項背強幾幾”與頸椎病的癥狀極為相像。目前已有不少文獻研究葛根湯及其加減對頸椎病的治療的臨床隨機試驗,但卻沒有葛根湯及其加減治療頸椎病的系統(tǒng)評價和Meta分析。本研究擬對葛根湯及其加減治療頸椎病進行系統(tǒng)評價和Meta分析,從而用科學可信的方法評價葛根湯的有效性和安全性,探討葛根湯的臨床價值,以期用循證醫(yī)學的方法為臨床實踐和與之相關(guān)的科學研究提供高級別的循證醫(yī)學證據(jù)。目的：對葛根湯及其加減治療頸椎病的隨機對照試驗進行系統(tǒng)評價和Meta分析,評價其療效和安全性。用循證醫(yī)學的方法為臨床實踐和與之相關(guān)的科學研究提供高級別的循證醫(yī)學證據(jù)。方法：計算機檢索中國知網(wǎng)(CNKI)、維普數(shù)據(jù)庫(VIP)、中國生物醫(yī)學文獻數(shù)據(jù)庫(CBM)、萬方數(shù)據(jù)庫、PubMed和Cochrane Library數(shù)據(jù)庫。時間截止到2016年。納入所有葛根湯及其加減治療頸椎病的隨機對照試驗。使用RevMan5.3軟件對納入的文獻進行Meta分析。計數(shù)資料采用優(yōu)勢比(odds ratio,OR),連續(xù)性變量資料采用均差(mean difference,MD)作為效應(yīng)評價,并提供95%可信區(qū)間(confidence interval,CI)表示結(jié)果。當試驗結(jié)果臨床異質(zhì)性在可接受范圍內(nèi),進行定量分析,考慮到中藥治療的復雜性,選用隨機效應(yīng)模型。若試驗結(jié)果異質(zhì)性較大,則用定性分析。試圖獲取的結(jié)局指標：主要結(jié)局指標為(1)總有效率；(2)VAS評分。次要結(jié)局指標：(1)不良反應(yīng)；(2)隨訪復發(fā)率。結(jié)果：共納入32項研究。Meta分析結(jié)果顯示：關(guān)于提高頸椎病的總有效率方面：1.葛根湯(加減)較單純口服非甾體類抗炎藥有優(yōu)勢；2單純葛根湯(加減)較單純口服中成藥(非葛根湯或其加減)有優(yōu)勢；3葛根湯(加減)結(jié)合針刺較單純針刺有優(yōu)勢；4葛根湯(加減)結(jié)合牽引較單純牽引有優(yōu)勢；5葛根湯(加減)結(jié)合推拿手法較單純推拿手法有優(yōu)勢；6葛根湯(加減)結(jié)合推拿手法較口服西藥(塞來昔布膠囊)結(jié)合推拿手法有優(yōu)勢。且定性分析顯示葛根湯(加減)可降低頸椎病疼痛的VAS評分。所有文獻中未發(fā)現(xiàn)不良反應(yīng)。治療神經(jīng)根型的文獻較多,頸型和椎動脈型次之,未單獨提到其他類型頸椎病。結(jié)論：葛根湯(加減)可以提高頸椎病患者的有效率,降低頸椎病疼痛的VAS評分,未發(fā)現(xiàn)有不良反應(yīng)。且對頸椎病的神經(jīng)根型,頸型,椎動脈型效果明顯
[Abstract]:Background: cervical spondylosis is a disease caused by cervical disc degeneration and cervical degeneration, such as neck, shoulder and upper limb pain and dysfunction, headache, vertigo and so on. It can be divided into cervical type, nerve root type, vertebral artery type, spinal cord type, sympathetic nerve type and mixed type. When each type of cervical spondylosis is serious, there will be symptoms such as pain and numbness of neck and shoulder, vertigo, nausea and so on, while cervical Spondylotic myelopathy will lead to lower extremity muscle strength decline, severe paralysis, seriously affecting the quality of life of patients. Traditional Chinese medicine decoction has long been mentioned in the ancient books of traditional Chinese medicine for the treatment of neck discomfort, and the provisions of Pugen decoction recorded in the Treatise on febrile Diseases mentioned "Sun disease, Xiang back strong, no sweat evil wind, Pugen decoction." Among them, "Xiang back strength several" and cervical spondylosis symptoms are very similar. At present, many literatures have studied the clinical randomized trials of Gegen decoction and its addition and subtraction in the treatment of cervical spondylosis, but there is no systematic evaluation and Meta analysis of Gegen decoction and its addition and subtraction in the treatment of cervical spondylosis. In this study, Gegen decoction and its addition and subtraction in the treatment of cervical spondylosis were systematically evaluated and analyzed by Meta, so as to evaluate the effectiveness and safety of Gegen decoction with scientific and credible methods, and to explore the clinical value of Gegen decoction. In order to provide high-level evidence-based medical evidence for clinical practice and related scientific research, evidence-based medicine (EBM) is used to provide evidence-based medicine (EBM) for clinical practice and related scientific research. Objective: to evaluate the efficacy and safety of Gegen decoction and its addition and subtraction in the treatment of cervical spondylosis by systematic evaluation and Meta analysis. Evidence-based medicine (EBM) is used to provide high-level evidence-based medical evidence for clinical practice and related scientific research. Methods: the Chinese biomedical literature database (CBM), Wanfang database, PubMed database and Cochrane Library database were searched by computer. The time ends in 2016. All Gegen decoction and its addition and subtraction were included in the randomized controlled trial of cervical spondylosis. Meta analysis of the included literature was carried out by using RevMan5.3 software. The advantage ratio (odds ratio,OR) was used for counting data, and the mean difference (mean difference,MD) was used as effect evaluation for continuous variable data, and 95% confidence interval (confidence interval,CI) was provided to represent the results. When the clinical heterogeneity of the trial results is within the acceptable range, quantitative analysis is carried out, and considering the complexity of traditional Chinese medicine treatment, the random effect model is selected. If the heterogeneity of the test results is large, the qualitative analysis is used. The main outcome indexes were (1) total efficiency and (2) VAS score. Secondary outcome indicators: (1) adverse reactions; (2) recurrence rate of follow-up. Results: a total of 32 studies were included. Meta-analysis showed that the total effective rate of cervical spondylosis was improved: 1. Gegen decoction (addition and subtraction) has advantages over simple oral non-steroidal anti-inflammatory drugs, (2) simple Gegen decoction (addition and subtraction) has advantages over simple oral Chinese patent medicine (non-Puergen decoction or its addition and subtraction), (3) Gegen decoction (addition and subtraction) combined with acupuncture has advantages over simple acupuncture; (4) Gegen decoction (addition and subtraction) combined with traction has advantages over simple traction, and (5) Gegen decoction (addition and subtraction) combined with massage has advantages over simple massage. Gegen decoction (addition and subtraction) combined with massage has advantages over oral western medicine (celecoxib capsule) combined with massage. Qualitative analysis showed that Gegen decoction could reduce the VAS score of cervical spondylosis pain. No adverse reactions were found in all the literature. There are many literatures on the treatment of nerve root type, followed by cervical type and vertebral artery type, and other types of cervical spondylosis are not mentioned alone. Conclusion: Gegen decoction can improve the effective rate of patients with cervical spondylosis and reduce the VAS score of cervical spondylosis pain. No adverse reactions were found. And it has obvious effect on nerve root type, cervical type and vertebral artery type of cervical spondylosis.
【學位授予單位】：黑龍江中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R274.9
[Abstract]:Background: cervical spondylosis is a disease caused by cervical disc degeneration and cervical degeneration, such as neck, shoulder and upper limb pain and dysfunction, headache, vertigo and so on. It can be divided into cervical type, nerve root type, vertebral artery type, spinal cord type, sympathetic nerve type and mixed type. When each type of cervical spondylosis is serious, there will be symptoms such as pain and numbness of neck and shoulder, vertigo, nausea and so on, while cervical Spondylotic myelopathy will lead to lower extremity muscle strength decline, severe paralysis, seriously affecting the quality of life of patients. Traditional Chinese medicine decoction has long been mentioned in the ancient books of traditional Chinese medicine for the treatment of neck discomfort, and the provisions of Pugen decoction recorded in the Treatise on febrile Diseases mentioned "Sun disease, Xiang back strong, no sweat evil wind, Pugen decoction." Among them, "Xiang back strength several" and cervical spondylosis symptoms are very similar. At present, many literatures have studied the clinical randomized trials of Gegen decoction and its addition and subtraction in the treatment of cervical spondylosis, but there is no systematic evaluation and Meta analysis of Gegen decoction and its addition and subtraction in the treatment of cervical spondylosis. In this study, Gegen decoction and its addition and subtraction in the treatment of cervical spondylosis were systematically evaluated and analyzed by Meta, so as to evaluate the effectiveness and safety of Gegen decoction with scientific and credible methods, and to explore the clinical value of Gegen decoction. In order to provide high-level evidence-based medical evidence for clinical practice and related scientific research, evidence-based medicine (EBM) is used to provide evidence-based medicine (EBM) for clinical practice and related scientific research. Objective: to evaluate the efficacy and safety of Gegen decoction and its addition and subtraction in the treatment of cervical spondylosis by systematic evaluation and Meta analysis. Evidence-based medicine (EBM) is used to provide high-level evidence-based medical evidence for clinical practice and related scientific research. Methods: the Chinese biomedical literature database (CBM), Wanfang database, PubMed database and Cochrane Library database were searched by computer. The time ends in 2016. All Gegen decoction and its addition and subtraction were included in the randomized controlled trial of cervical spondylosis. Meta analysis of the included literature was carried out by using RevMan5.3 software. The advantage ratio (odds ratio,OR) was used for counting data, and the mean difference (mean difference,MD) was used as effect evaluation for continuous variable data, and 95% confidence interval (confidence interval,CI) was provided to represent the results. When the clinical heterogeneity of the trial results is within the acceptable range, quantitative analysis is carried out, and considering the complexity of traditional Chinese medicine treatment, the random effect model is selected. If the heterogeneity of the test results is large, the qualitative analysis is used. The main outcome indexes were (1) total efficiency and (2) VAS score. Secondary outcome indicators: (1) adverse reactions; (2) recurrence rate of follow-up. Results: a total of 32 studies were included. Meta-analysis showed that the total effective rate of cervical spondylosis was improved: 1. Gegen decoction (addition and subtraction) has advantages over simple oral non-steroidal anti-inflammatory drugs, (2) simple Gegen decoction (addition and subtraction) has advantages over simple oral Chinese patent medicine (non-Puergen decoction or its addition and subtraction), (3) Gegen decoction (addition and subtraction) combined with acupuncture has advantages over simple acupuncture; (4) Gegen decoction (addition and subtraction) combined with traction has advantages over simple traction, and (5) Gegen decoction (addition and subtraction) combined with massage has advantages over simple massage. Gegen decoction (addition and subtraction) combined with massage has advantages over oral western medicine (celecoxib capsule) combined with massage. Qualitative analysis showed that Gegen decoction could reduce the VAS score of cervical spondylosis pain. No adverse reactions were found in all the literature. There are many literatures on the treatment of nerve root type, followed by cervical type and vertebral artery type, and other types of cervical spondylosis are not mentioned alone. Conclusion: Gegen decoction can improve the effective rate of patients with cervical spondylosis and reduce the VAS score of cervical spondylosis pain. No adverse reactions were found. And it has obvious effect on nerve root type, cervical type and vertebral artery type of cervical spondylosis.
【學位授予單位】：黑龍江中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R274.9
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1 崔昕;葛根湯的療效[J];國外醫(yī)學(中醫(yī)中藥分冊);1997年01期
2 朱世杰,王澤梅;葛根湯治目{，
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