中医药治疗强直性脊柱炎疗效的Meta分析
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摘要
目的:系统评价中医药治疗强直性脊柱炎的临床疗效。方法:计算机检索中国知网(CNKI)、万方数据库、香港文学资料库、台湾学术期刊在线数据库、Cochrane library、Pub Med数据库,纳入2014年至2018年中医药治疗强直性脊柱炎的随机对照研究文献,使用RevMan 5.3统计软件对资料进行Meta分析。结果:最终纳入8篇随机对照研究,其中7篇为中文文献,1篇为英文文献,共674例强直性脊柱炎患者。Meta分析结果显示,中医药治疗强直性脊柱炎可降低Bath强直性脊柱炎活动指数(BASDAI)(MD=-3.53,95%CI=[-5.08,-1.97])、Bath强直性脊柱炎功能指数(BASFI)(MD=-1.85,95%CI=[-2.46,-1.24])、C-反应蛋白(CRP)(MD=-5.49,95%CI=[-7.71,-3.26])和红细胞沉降率(ESR)(MD=-5.52,95%CI=[-8.69,-2.35]);还可改善患者脊柱痛(MD=-1.73,95%CI=[-2.13,-1.33])和枕墙距(MD=-0.36,95%CI=[-0.48,-0.23]);但在改善患者指地距(MD=-5.17,95%CI=[-10.52,0.18])和胸廓活动度(MD=0.17,95%CI=[-0.17,0.50])方面,差异无统计学意义;治疗组患者总体评价(PGA)(MD=-0.90,95%CI=[-1.33,-0.47])和临床总有效率(MD=5.17,95%CI=[2.98,8.96])与对照组比较,差异有统计学意义。结论:中医药治疗强直性脊柱炎能够降低炎症反应,改善患者BASDAI、BASFI、脊柱痛、枕墙距和PGA,在治疗强直性脊柱炎的总体疗效上要优于单纯西药治疗,且不良反应少,但在改善患者指地距和胸廓活动度上无明显优势。
Objective:To systematically evaluate the clinical efficacy of TCM in the treatment of ankylosing spondylitis.Methods:The randomized controlled literature of TCM treatment of ankylosing spondylitis from 2014 to 2018 was retrieved by computer from CNKI,Wanfang database,Hong Kong literature database,online database of Taiwan academic journals,Cochrane library and PubMed database.RevMan 5.3 statistical software was used to make a meta-analysis for the data.Results:Eight randomized controlled studies were included,including one in English and seven in Chinese.There are a total of 674 patients with ankylosing spondylitis.Meta-analysis showed that the treatment of ankylosing spondylitis with TCM could reduce BASDAI(MD =-3.53,95%CI = [-5.08,-1.97]),BASFI(MD =-1.85,95%CI = [-2.46,-1.24]),CRP(MD =-5.49,95%CI= [-7.71,-3.26])and ESR(MD =-5.52,95%CI = [-8.69,-2.35]),and improve spinal pain(MD =-1.73,95% CI = [-2.13,-1.33])and occipital wall distance(MD =-0.36,95%CI =[-0.48,-0.23]),but there was no significant difference in the improvement of finger-to-ground distance(MD=-5.17,95%CI = [-10.52,0.18])and thoracic activity(MD = 0.17,95%CI =[-0.17,0.50]).There was a statistical significance of PGA(MD =-0.90,95%CI = [-1.33,-0.47])and the total clinical efficacy(MD = 5.17,95%CI = [2.98,8.96])between the two groups.Conclusion:Treating ankylosing spondylitis with TCM can reduce inflammation,improve BASDAI,BASFI,spinal pain,occipital wall distance and PGA in patients with ankylosing spondylitis.The overall efficacy is better than that with Western medicine alone,with fewer adverse reactions,but there is no obvious advantage in improving finger-to-ground distance and chest mobility.
Objective:To systematically evaluate the clinical efficacy of TCM in the treatment of ankylosing spondylitis.Methods:The randomized controlled literature of TCM treatment of ankylosing spondylitis from 2014 to 2018 was retrieved by computer from CNKI,Wanfang database,Hong Kong literature database,online database of Taiwan academic journals,Cochrane library and PubMed database.RevMan 5.3 statistical software was used to make a meta-analysis for the data.Results:Eight randomized controlled studies were included,including one in English and seven in Chinese.There are a total of 674 patients with ankylosing spondylitis.Meta-analysis showed that the treatment of ankylosing spondylitis with TCM could reduce BASDAI(MD =-3.53,95%CI = [-5.08,-1.97]),BASFI(MD =-1.85,95%CI = [-2.46,-1.24]),CRP(MD =-5.49,95%CI= [-7.71,-3.26])and ESR(MD =-5.52,95%CI = [-8.69,-2.35]),and improve spinal pain(MD =-1.73,95% CI = [-2.13,-1.33])and occipital wall distance(MD =-0.36,95%CI =[-0.48,-0.23]),but there was no significant difference in the improvement of finger-to-ground distance(MD=-5.17,95%CI = [-10.52,0.18])and thoracic activity(MD = 0.17,95%CI =[-0.17,0.50]).There was a statistical significance of PGA(MD =-0.90,95%CI = [-1.33,-0.47])and the total clinical efficacy(MD = 5.17,95%CI = [2.98,8.96])between the two groups.Conclusion:Treating ankylosing spondylitis with TCM can reduce inflammation,improve BASDAI,BASFI,spinal pain,occipital wall distance and PGA in patients with ankylosing spondylitis.The overall efficacy is better than that with Western medicine alone,with fewer adverse reactions,but there is no obvious advantage in improving finger-to-ground distance and chest mobility.
引文
[1]于盈盈,茅建春.强直性脊柱炎的中医治疗进展[J].吉林中医药,2019,39(1):136-139.
[2]赵立书,张高迎,唐巍.强直性脊柱炎中医证治思路[J].长春中医药大学学报,2016,32(1):64-67.
[3]钱佳丽,余毅,毛盈颖,等.强直性脊柱炎家系流行病学调查和中医体质分析[J].中华中医药杂志,2017,32(12):5599-5602.
[4]黄立,王明怀,赵海艳.化痰通瘀止痛方配合中医正骨手法治疗强直性脊柱炎50例[J].环球中医药,2018,11(10):1582-1585.
[5]陈彦,禇强,徐斌斌.中医综合疗法治疗强直性脊柱炎临床观察[J].新中医,2018,50(11):125-128.
[6]张志强,吕新亮.中西医结合治疗强直性脊柱炎的meta分析[J].世界最新医学信息文摘,2018,18(79):193-194.
[7]VAN DER LINDEN S,VALKENBURG HA,CATS A.Evaluation of diagnostic criteria for ankylosing spondylitis.A proposal for modification of the New York criteria[J].Arthritis Rheum,1984,27(4):361-368.
[8]田新平,曾小峰.风湿病学[M].北京:人民卫生出版社,2009:94-107.
[9]胡绍先.风湿病诊疗指南[M].北京:科学出版社,2013:116-122.
[10]国家中医药管理局.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:119.
[11]HIGGINS JPT,GREEN S.Cochrane hand book for systematic reviews of interventions version 5.1.0[M/OL].(2011-03-20).http://www.training.cochrane.org/handbook.
[12]张媛,佟宇,张达义.十二味地黄汤治疗强直性脊柱炎疗效观察[J].中国煤炭工业医学杂志,2016,19(11):1628-1632.
[13]杨吉勇.中西医结合治疗强直性脊柱炎42例临床观察[J].湖南中医杂志,2016,32(11):15-17,24.
[14]LI Q,LI L,BI L,et al.Kunxian capsules in the treatment of patients with ankylosing spondylitis:a randomized placebo-controlled clinical trial[J].Trials,2016,17(1):337.
[15]高巧霞.督灸联合补肾祛寒化湿中药治疗强直性脊柱炎肾虚督寒证疗效及对ESR、炎性细胞因子的影响[J].现代中西医结合杂志,2017,26(10):1103-1106.
[16]吴辉辉,杨光辉,郑玥琪,等.中西医结合治疗强直性脊柱炎的临床观察[J].上海中医药杂志,2017,51(S1):105-108.
[17]邵培培,温博,张秦,等.颈椎康复丸治疗肝郁肾虚型强直性脊柱炎临床观察[J].北京中医药,2018,37(7):683-686.
[18]王春苹,阎小萍.补肾强督祛寒汤治疗强直性脊柱炎的临床观察[J].中国中医药现代远程教育,2018,16(24):51-54.
[19]贾淑丽,曹海利,高立录,等.二仙健骨方联合针灸疗法治疗强直性脊柱炎疗效观察[J].中医学报,2018,33(8):1558-1562.
[20]郑桂华,邱明山.强直性脊柱炎合并严重肾损害1例及其文献分析[J].风湿病与关节炎,2018,7(11):39-41.
[21]彭兰驭,牟茂婷,杨爽,等.强直性脊柱炎的药物治疗现状与进展[J].世界最新医学信息文摘,2018,18(98):83-85.
[22]杨少祥,郑福增,孟庆良,等.强直性脊柱炎的中西医治疗研究进展[J].风湿病与关节炎,2017,6(7):77-80.
[23]姫元庆,张九妹.中药复方对强直性脊柱炎防治的研究进展[J].中国骨质疏松杂志,2018,24(5):681-685.
[24]郑晓宇.针灸在强直型脊柱炎的应用进展[J].山东医学高等专科学校学报,2018,40(3):236-238.
[25]董龙聪,邓路达,兰维娅,等.督灸治疗强直性脊柱炎临床疗效的Meta分析[J].风湿病与关节炎,2018,7(9):30-35.
[2]赵立书,张高迎,唐巍.强直性脊柱炎中医证治思路[J].长春中医药大学学报,2016,32(1):64-67.
[3]钱佳丽,余毅,毛盈颖,等.强直性脊柱炎家系流行病学调查和中医体质分析[J].中华中医药杂志,2017,32(12):5599-5602.
[4]黄立,王明怀,赵海艳.化痰通瘀止痛方配合中医正骨手法治疗强直性脊柱炎50例[J].环球中医药,2018,11(10):1582-1585.
[5]陈彦,禇强,徐斌斌.中医综合疗法治疗强直性脊柱炎临床观察[J].新中医,2018,50(11):125-128.
[6]张志强,吕新亮.中西医结合治疗强直性脊柱炎的meta分析[J].世界最新医学信息文摘,2018,18(79):193-194.
[7]VAN DER LINDEN S,VALKENBURG HA,CATS A.Evaluation of diagnostic criteria for ankylosing spondylitis.A proposal for modification of the New York criteria[J].Arthritis Rheum,1984,27(4):361-368.
[8]田新平,曾小峰.风湿病学[M].北京:人民卫生出版社,2009:94-107.
[9]胡绍先.风湿病诊疗指南[M].北京:科学出版社,2013:116-122.
[10]国家中医药管理局.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:119.
[11]HIGGINS JPT,GREEN S.Cochrane hand book for systematic reviews of interventions version 5.1.0[M/OL].(2011-03-20).http://www.training.cochrane.org/handbook.
[12]张媛,佟宇,张达义.十二味地黄汤治疗强直性脊柱炎疗效观察[J].中国煤炭工业医学杂志,2016,19(11):1628-1632.
[13]杨吉勇.中西医结合治疗强直性脊柱炎42例临床观察[J].湖南中医杂志,2016,32(11):15-17,24.
[14]LI Q,LI L,BI L,et al.Kunxian capsules in the treatment of patients with ankylosing spondylitis:a randomized placebo-controlled clinical trial[J].Trials,2016,17(1):337.
[15]高巧霞.督灸联合补肾祛寒化湿中药治疗强直性脊柱炎肾虚督寒证疗效及对ESR、炎性细胞因子的影响[J].现代中西医结合杂志,2017,26(10):1103-1106.
[16]吴辉辉,杨光辉,郑玥琪,等.中西医结合治疗强直性脊柱炎的临床观察[J].上海中医药杂志,2017,51(S1):105-108.
[17]邵培培,温博,张秦,等.颈椎康复丸治疗肝郁肾虚型强直性脊柱炎临床观察[J].北京中医药,2018,37(7):683-686.
[18]王春苹,阎小萍.补肾强督祛寒汤治疗强直性脊柱炎的临床观察[J].中国中医药现代远程教育,2018,16(24):51-54.
[19]贾淑丽,曹海利,高立录,等.二仙健骨方联合针灸疗法治疗强直性脊柱炎疗效观察[J].中医学报,2018,33(8):1558-1562.
[20]郑桂华,邱明山.强直性脊柱炎合并严重肾损害1例及其文献分析[J].风湿病与关节炎,2018,7(11):39-41.
[21]彭兰驭,牟茂婷,杨爽,等.强直性脊柱炎的药物治疗现状与进展[J].世界最新医学信息文摘,2018,18(98):83-85.
[22]杨少祥,郑福增,孟庆良,等.强直性脊柱炎的中西医治疗研究进展[J].风湿病与关节炎,2017,6(7):77-80.
[23]姫元庆,张九妹.中药复方对强直性脊柱炎防治的研究进展[J].中国骨质疏松杂志,2018,24(5):681-685.
[24]郑晓宇.针灸在强直型脊柱炎的应用进展[J].山东医学高等专科学校学报,2018,40(3):236-238.
[25]董龙聪,邓路达,兰维娅,等.督灸治疗强直性脊柱炎临床疗效的Meta分析[J].风湿病与关节炎,2018,7(9):30-35.