摘要
[目的]运用循证医学的方法对穴位贴敷疗法治疗慢性阻塞性肺疾病(COPD)的临床疗效和安全性进行系统分析和Grade评价。[方法]计算机检索国内外中英文数据库,检索从各数据库建库至2022年9月31日发表的关于穴位贴敷治疗COPD的随机对照研究(RCT),由两名研究员背对背根据纳入标准及排除标准进行筛查,应用Revman 5.3软件做偏倚风险评估及Meta分析,应用Grade系统进行证据质量评价。[结果]共纳入16篇文献、1500例患者,包括治疗组751例,对照组749例,Meta分析结果显示:与单纯西医治疗相比,穴位贴敷提高总有效率(TE)[OR=4.68,95%CI(3.36,6.53),P<0.00001],改善第1秒用力呼气量占预计值的百分比(FEV1%)[MD=3.04,95%CI(1.76,4.33),P<0.00001]、第一秒用力呼气量/最大肺活量比值(FEV1/FVC)[MD=2.38,95%CI(0.84,3.92),P=0.002],改善动脉血氧分压(PaO2)[MD=7.27,95%CI(4.60,9.95),P<0.00001]、动脉血二氧化碳分压(PaCO_(2))[MD=-8.68,95%CI(-10.28,-7.09),P<0.00001],圣乔治呼吸问卷(SGRQ)、呼吸相关量表(BODE指数、CAT评分)均有明显降低[MD=-7.36,95%CI(-13.22,-1.51),P=0.01;MD=-0.74,95%CI(-0.80,-0.69),P<0.00001;MD=-1.92,95%CI(-2.73,-1.10),P<0.00001],减少急性加重次数[MD=-1.85,95%CI(-2.67,-1.03),P<0.00001],增加不良反应发生率[OR=2.89,95%CI(1.57,5.33),P=0.0007],中医证候积分组间无差异[MD=-0.87,95%CI(-1.84,0.09),P=0.08],Grade证据分级结果显示:FEV1/FVC、PaCO_(2)、不良反应发生率3项结局指标为中质量证据,临床总有效率、FEV1%、CAT评分、急性加重次数4项结局指标为低质量证据,中医证候总积分、PaO2、SGQR评分、BODE指数4项结局指标为极低质量证据。[结论]穴位贴敷联合西医治疗COPD比单纯西医治疗有明显优势,但所纳入研究的证据质量不高,尚需高质量研究为临床提供指导。
[Objective]To systematically analyze and evaluate Grade on the clinical efficacy and safety of acupoint application therapy in chronic obstructive pulmonary disease(COPD)by using evidence-based medicine.[Methods]A computer search of Chinese and English databases at home and abroad was conducted to retrieve randomized controlled trials(RCTs)on acupoint application in the treatment of COPD published from the establishment of each database to September 31,2022.Screening was performed by two researchers back-to-back according to the inclusion criteria and exclusion criteria.Review Manager 5.3 software was used for bias risk assessment and Meta-analysis,and Grade system was used for evidence quality evaluation.[Results]A total of 16 references with 1500 patients were included(751 patients in the treatment group and 749 patients in the control group).The results of Metaanalysis showed that compared with conventional western medicine,acupoint application was more effective in total response efficiency(TE)[OR=4.68,95%CI(3.36,6.53),P<0.00001],with a superior advantage in increasing the forced expiratory volume in the first second as a percentage of the expected value(FEV1%)[MD=3.04,95%CI(1.76,4.33),P<0.00001]and the first-second forced expiratory volume/maximum vital capacity ratio(FEV1/FVC)[MD=2.38,95%CI(0.84,3.92),P=0.002],improving arterial blood oxygen partial pressure(PaO_(2))[MD=7.27,95%CI(4.60,9.95),P<0.00001]and reducing arterial blood carbon dioxide partial pressure(PaCO_(2))[MD=-8.68,95%CI(-10.28,-7.09),P<0.00001],and decreasing the St.George’s Respiratory Questionnaire(SGRQ),Respiratory correlation scale(the BODE index and the CAT score)[MD=-7.36,95%CI(-13.22,-1.51),P=0.01;MD=-0.74,95%CI(-0.80,-0.69),P<0.00001;MD=-1.92,95%CI(-2.73,-1.10),P<0.00001].Acupoint application could also reduce the number of acute exacerbation[MD=-1.85,95%CI(-2.67,-1.03),P<0.00001],but in a degree increase the incidence of adverse effects[OR=2.89,95%CI(1.57,5.33),P=0.0007].There was no differentiation between traditional Chinese medi
作者
王梁敏
唐玲
石明杰
季坤
郭淑娟
徐婧
白梅
赵丹丹
WANG Liangmin;TANG Ling;SHI Mingjie;JI Kun;GUO Shujuan;XU Jing;BAI Mei;ZHAO Dandan(Department of Fever and Respiratory disease,Dongfang Hospital Beijing University of Chinese Medicine,Beijing 100078,China;Department of Nursing,Dongfang Hospital Beijing University of Chinese Medicine,Beijing 100078,China;Beijing University of Chinese Medicine,Beijing 100029,China;Department of Pharmacy,Dongfang Hospital Beijing University of Chinese Medicine,Beijing 100078,China)
出处
《天津中医药》
CAS
2023年第10期1292-1303,共12页
Tianjin Journal of Traditional Chinese Medicine
基金
2021年度中国民族医药学会科研项目(2021Z1150-510901)。
