中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (2): 320-328.doi: 10.3969/j.issn.2095-4344.1919

• 组织构建循证医学 evidence-based medicine in tissue construction • 上一篇    

针灸联合多种方法治疗骨质疏松的网状Meta分析

岑卓灏,陈洁娜,黄嘉华,石础硕,周  驰,温俊茂,凌  敏   

  1. 广州中医药大学,广东省广州市  510405
  • 收稿日期:2019-03-28 修回日期:2019-04-03 接受日期:2019-04-30 出版日期:2020-01-18 发布日期:2019-12-24
  • 通讯作者: 凌敏,副教授,硕士生导师,广州中医药大学,广东省广州市 510405
  • 作者简介:岑卓灏,男,1995年生,广东省肇庆市人,2020年广州中医药大学毕业,硕士,主要从事运动医学方面的研究。
  • 基金资助:
    国家自然科学基金(81373655);广东省自然科学基金(2015A030310203);广东省高水平大学建设项目(A1-AFD018171Z11057)

Acupuncture combined with other therapies for osteoporosis: a network meta-analysis

Cen Zhuohao, Chen Jiena, Huang Jiahua, Shi Chushuo, Zhou Chi, Wen Junmao, Ling Min   

  1. Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Received:2019-03-28 Revised:2019-04-03 Accepted:2019-04-30 Online:2020-01-18 Published:2019-12-24
  • Contact: Ling Min, Associate professor, Master’s supervisor, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • About author:Cen Zhuohao, Master, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Supported by:
    the National Natural Science Foundation of China, No. 81373655; the Natural Science Foundation of Guangdong Province, No. 2015A030310203; the High-Level University Construction Project of Guangdong Province, No. A1-AFD018171Z11057

摘要:

文题释义:

网状 Meta 分析:是传统Meta分析的扩展,可以同时比较3个或者3个以上的干预措施的疗效。但是目前对网状Meta分析的定义相对混乱,按照“国际药物经济学和结果研究协会”的报告,网状Meta分析包括调整间接比较和混合治疗分析。混合治疗分析是在直接比较的基础上合并间接比较的证据,从而提高分析结果的精确性,但是这种方法主要是应用于干预措施可以形成具有闭合环路(loop)时。网状Meta分析的最大优势就是可以对治疗同类疾病的不同干预措施进行量化比较,并按照某一结果指标效果好坏进行排序,进而选择最优治疗方案。

针灸:是一门独具特色的传统医学学科。临床上,常将针灸作用于经络腧穴以防治疾病的方法和技术,称之为针灸疗法。针灸具有适应证广、疗效明显、应用方便、经济安全等优点。

背景:针灸及其联合其他疗法与标准西医疗法之间比较治疗骨质疏松有效性的研究结论存在争议,现有的原始研究和 Meta 分析多为单一针灸治疗、针灸联合西药治疗与标准西医疗法间的比较,缺乏针灸联合其他疗法之间的直接比较,使人们难以对针灸疗效有较清晰、全面的认识。

目的:采用网状Meta分析技术,比较针灸联合其他疗法治疗骨质疏松疗效的差异。

方法:在CNKI、维普、万方、SinoMed、PubMed、Cochrane Library数据库上进行检索,纳入不同针灸疗法对比治疗骨质疏松的临床随机对照试验(RCT)。根据相关纳入与排除标准对文献进行筛选后提取相关资料,并对纳入文献进行质量评价。运用Stata 14.0软件进行文献数据分析及作图。

结果与结论:最终纳入34篇随机对照试验,共涉及7种干预措施,包括:单一针灸治疗,单一西药治疗,单一中药治疗,针灸+西药联合治疗,针灸+中药联合治疗,中药+西药治疗,针灸+中药+西药联合治疗。①在治疗有效率上,针灸+中药的疗效最佳,且针灸+中药、针灸+西药以及针灸+中药+西药,均显著比中药+西药治疗的有效率高(P < 0.05);②在增加患者骨密度方面,针灸+中药、针灸+西药以及针灸+中药+西药,均优于单一中药或西药组(P < 0.05);③在缓解患者疼痛方面,与单一西药治疗相比,针灸+西药治疗能缓解患者的疼痛(P < 0.05),但其余治疗方式之间,并无明显的差异(P > 0.05)。在纳入的研究中,有极少数患者出现针刺后穴位瘀血现象,但均未出现晕针或未报道,也未发现其他毒副作用。提示:针灸联合其他疗法,可以提高有效率、增加骨密度、缓解患者疼痛。

ORCID: 0000-0001-7755-5563(岑卓灏)

中国组织工程研究杂志出版内容重点:组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松组织工程

关键词: 针灸, 中药, 骨质疏松, 治疗有效率, 骨密度, 疼痛积分, 网状Meta分析, 联合治疗

Abstract:

BACKGROUND: Comparative study results between the treatment efficiency of acupuncture plus other combination therapy and western medicine therapy in the treatment of knee osteoarthritis remain controversial. Currently, meta-analysis studies mainly focus on comparison of the efficacy between single acupuncture treatment, acupuncture plus western medicine combination therapy and western medicine, but there is a lack of investigation on acupuncture combined with other therapies. It is difficult to fully understand the efficacy of acupuncture.

OBJECTIVE: To compare the effects of acupuncture therapy, conventional western medicine and Chinese medicine on osteoporosis treatment by network meta-analysis.

METHODS: A search was performed on the CNKI, VIP, WanFang, SinoMed, PubMed, and Cochrane Library databases to include the randomized controlled trials of different acupuncture treatments for osteoporosis. Relevant data were extracted after screening the literature according to relevant inclusion and exclusion criteria, and the quality of the included literature was evaluated. Literature data analysis and mapping were performed using Stata 14.0 software.

RESULTS AND CONCLUSION: Thirty-four randomized controlled trials were included, involving seven interventions, such as single acupuncture treatment, single western medicine treatment, single Chinese medicine treatment, acupuncture plus western medicine combination therapy, acupuncture plus Chinese medicine combination therapy, Chinese medicine + western medicine treatment, acupuncture + Chinese medicine + western medicine combined treatment. (1) In the treatment efficiency, acupuncture combined with traditional Chinese medicine is the best in the treatment of primary osteoporosis, and acupuncture combined with traditional Chinese medicine, acupuncture combined with western medicine and acupuncture combined with traditional Chinese medicine western medicine were significantly better than traditional Chinese medicine combined with western medicine (P < 0.05). (2) In increasing the bone mineral density of patients, acupuncture combined with traditional Chinese medicine, acupuncture combined with western medicine and acupuncture combined with traditional Chinese medicine western medicine increased the bone density compared with single Chinese medicine or western medicine (P < 0.05). (3) In terms of relieving pain in patients, the results of this study showed that compared with single western medicine, acupuncture combined with western medicine can relieve the pain of patients to some extent (P < 0.05), but there was no significant difference between the other treatment methods (P > 0.05). In the included studies, a very small number of patients developed acupuncture and blood stasis after acupuncture, but no fainting or unreported, and no other side effects were found. To conclude, acupuncture combined with other therapies can improve the efficiency, increase the bone mineral density and alleviate pain. 

Key words: acupuncture, traditional Chinese medicine, osteoporosis, treatment efficiency, bone mineral density, pain score, network meta-analysis, combined treatment

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