【摘要】：目的:系統評價中藥蒸氣浴結合常規(guī)療法治療膝關節(jié)骨性關節(jié)炎的臨床療效。方法:由兩名系統評價員提取檢索關鍵詞,制定科學有效的文獻檢索策略,運用計算機檢索中國知網(CNKI)、中國生物醫(yī)學文獻數據庫(CBM)、維普數據庫(VIP)、萬方數字化期刊群(WF)、Pubmed數據庫中近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合其他常規(guī)療法治療KOA為治療組,以對應的常規(guī)療法治療KOA為對照組的隨機對照研究,制定納入標準和排除標準,納入符合標準的文獻18篇。根據Cochrane Handbook5.1推薦的偏倚風險評估工具,對納入文獻的質量進行評價,并運用Revman5.3軟件分析收集到的數據,亞組分析則是根據結合不同的常規(guī)療法分組,共分成4個亞組,分別是:“中藥蒸氣浴”亞組、“中藥蒸氣浴結合電針”亞組、“中藥蒸氣浴結合口服美洛昔康+氨基葡萄糖”亞組、“中藥蒸氣浴結合關節(jié)腔注射玻璃酸鈉”亞組,結局評價指標采用臨床有效率。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質量分級系統GRADE對結局指標的證據質量進行分級。結果: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Meta分析結果顯示,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,說明偏倚風險小。亞組分析結果:“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,“中藥蒸氣浴結合關節(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分級結果:中藥蒸氣浴結合常規(guī)療法與單純采用常規(guī)療法治療膝關節(jié)骨性關節(jié)炎的證據等級為低級,“中藥蒸氣浴”亞組的證據等級為極低級,“中藥蒸氣浴結合電針”亞組的證據等級為低級,“中藥蒸氣浴結合口服美洛昔康+氨基葡萄糖”亞組的證據等級為極低級,“中藥蒸氣浴結合關節(jié)腔注射玻璃酸鈉”亞組的證據等級為低級。結論:中藥蒸氣浴結合常規(guī)療法治療膝關節(jié)骨性關節(jié)炎的療效優(yōu)于單純采用常規(guī)療法;“中藥蒸氣浴”、“中藥蒸氣浴結合電針”、“中藥蒸氣浴結合關節(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”;但是系統評價結果的GRADE分級均為低級和極低級,證據級別較低,同時需要提供更多大規(guī)模、多中心、高質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.
【學位授予單位】：遼寧中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R274.9

【參考文獻】

相關期刊論文 前10條

1 先小樂;肖相如;;中醫(yī)治未病理論溯源[J];河南中醫(yī);2016年06期

2 張道虎;左建國;楊世明;;中藥熏蒸治療膝關節(jié)骨性關節(jié)炎臨床療效分析[J];四川中醫(yī);2015年08期

3 劉永;;中藥熏蒸聯合玻璃酸鈉關節(jié)腔注射治療膝關節(jié)骨性關節(jié)炎31例[J];中國中醫(yī)藥現代遠程教育;2014年24期

4 張文靜;陳遠虹;周裕倉;;疏筋通痹湯熏蒸結合電針治療膝關節(jié)骨性關節(jié)炎40例觀察[J];實用中醫(yī)藥雜志;2014年12期

5 楊子新;;中藥熏蒸治療膝關節(jié)骨性關節(jié)炎的臨床療效分析[J];中外醫(yī)學研究;2014年19期

6 陶競杰;周長征;;透藥療法聯合玻璃酸鈉治療膝關節(jié)骨性關節(jié)炎30例[J];湖南中醫(yī)雜志;2014年02期

7 胡勇斌;陳凌云;盧偉民;俞能寶;;“痹證方”熏蒸治療膝關節(jié)骨性關節(jié)炎臨床療效觀察[J];中國民康醫(yī)學;2014年04期

8 侯德才;;膝關節(jié)骨性關節(jié)炎的分期治療[J];中醫(yī)正骨;2014年01期

9 葛訊;蔡大衛(wèi);王灝;蔡保明;蔣青;;膝關節(jié)骨性關節(jié)炎的臨床分期及階梯治療[J];中國醫(yī)藥指南;2014年01期

10 江彬;侯小琦;唐占英;;溫針灸治療膝關節(jié)骨性關節(jié)炎的臨床研究[J];中國中醫(yī)骨傷科雜志;2013年11期

相關碩士學位論文 前1條

1 李占標;針刀松解治療膝關節(jié)骨性關節(jié)炎的臨床研究[D];山東中醫(yī)藥大學;2013年

，

本文編號：2366575