活血化瘀类中药治疗神经根型颈椎病有效性和安全性的系统评价  

Clinical efficacy and safety of blood act stasis remov drugs for treatment of cervical spondylotic radiculopathy:a systematic review

作　　者：许金海[1] 杨爱民 施问民 王晶[1] 王国栋[1] 周晓宁 匡昱林 乔娇娇 叶洁[1] 莫文[1] 施杞[1] XU Jinhai;YANG Aimin;SHI Wenmin;WANG Jing;WANG Guodong;ZHOU Xiaoning;KUANG Yulin;QIAO Jiaojiao;YE Jie;MO Wen;SHI Qi(Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Shanghai Punan Hospital of Pudong New District,Shanghai 200125,China)

机构地区：[1]上海中医药大学附属龙华医院,上海200032 [2]上海市浦东新区浦南医院,上海200125

出　　处：《中医正骨》2019年第12期20-28,共9页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：国家自然科学基金项目(81603635);上海市科学技术委员会科研计划项目(17401934400,19401901100);上海申康医院发展中心项目(16CR4011A);上海市进一步加快中医药事业发展三年行动计划项目[ZY(2018-2020)-FWTX-4002]

摘　　要：目的:系统评价活血化瘀类中药治疗神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的有效性和安全性。方法:计算机检索Cochrane Library、PubMed、EMbase、CNKI、万方数据库、维普全文期刊数据库、中国生物医学文献光盘数据库,检索年限均设定为建库至2019年1月31日。对纳入的文献进行方法学质量评估并提取有效数据,采用Revman5.3软件进行Meta分析。结果:系统评价共纳入41篇文献,涉及4079例受试者。Meta分析结果显示,活血化瘀类中药治疗CSR的总有效率高于西药治疗[I^2=0%,OR=2.90,95%CI(1.98,4.26)];活血化瘀类中药结合非药物疗法治疗CSR的总有效率高于非药物疗法[I^2=0%,OR=4.13,95%CI(2.97,5.75)];活血化瘀类中药治疗CSR的治愈率高于西药治疗[I^2=27%,OR=2.32,95%CI(1.67,3.24)];活血化瘀类中药结合非药物疗法治疗CSR的治愈率高于非药物疗法[I^2=0%,OR=2.38,95%CI(1.85,3.07)];活血化瘀类中药治疗CSR的治疗后疼痛视觉模拟量表(visual analogue scale,VAS)评分低于安慰剂治疗[I^2=87%,MD=-13.56,95%CI(-22.44,-4.68)];活血化瘀类中药与西药治疗CSR的治疗后疼痛VAS评分差异无统计学意义[I^2=76%,MD=-0.33,95%CI(-0.89,-0.23)];活血化瘀类中药结合非药物疗法治疗CSR的治疗后疼痛VAS评分低于非药物疗法[I^2=96%,MD=-1.38,95%CI(-1.92,-0.84)];活血化瘀类中药治疗CSR的治疗后颈椎功能障碍指数(neck disability index,NDI)低于安慰剂治疗[I^2=0%,MD=-3.26,95%CI(-4.96,-1.55)];活血化瘀类中药与西药治疗CSR的治疗后神经根型颈椎病疗效评分差异无统计学意义[I^2=95%,OR=0.96,95%CI(-0.65,2.57)]。活血化瘀类中药造成的不良反应较轻,且少于消炎止痛类西药。结论:现有证据表明,活血化瘀类中药治疗CSR总体疗效较好,且较为安全。Objective:To systematically review the clinical efficacy and safety of blood act stasis remov drugs for treatment of cervical spondylotic radiculopathy(CSR). Methods:The articles included from database establishing to January 31,2019 were retrieved from Cochrane Library,PubMed,EMbase,CNKI,WanFang Database,Vip database and CBMdisc through computer.The methodological quality of research in the articles was evaluated and the valid data were extracted and a Meta-analysis was conducted by using Revman5.3 software.Results:Forty-one articles(4079 patients)were included in the final analysis.The results of Meta-analysis demonstrated that the total effective rate was higher in patients who received blood act stasis remov drugs compared to patients who received western medicine and was higher in patients who received combination of blood act stasis remov drugs with non-drug therapy compared to patients who received non-drug therapy for treatment of CSR(I^2=0%,OR=2.90,95%CI(1.98,4.26);I^2=0%,OR=4.13,95%CI(2.97,5.75)).The cure rate was higher in patients who received blood act stasis remov drugs compared to patients who received western medicine and was higher inpatients who received combination of blood act stasis remov drugs with non-drug therapy compared to patients who received non-drug therapy for treatment of CSR(I^2=27%,OR=2.32,95%CI(1.67,3.24);I^2=0%,OR=2.38,95%CI(1.85,3.07)).The posttreatment pain visual analogue scale(VAS)scores were lower in patients who received blood act stasis remov drugs compared to patients who received placebo for treatment of CSR(I^2=87%,MD=-13.56,95% CI(-22.44,-4.68)).There was no statistical difference in posttreatment pain VAS scores between patients who received blood act stasis remov drugs and patients who received western medicine for treatment of CSR(I^2=76%,MD=-0.33,95%CI(-0.89,-0.23)).The posttreatment pain VAS scores were lower in patients who received combination of blood act stasis remov drugs with non-drug therapy compared to patients who received non-drug therapy for treatment

关 键 词：活血祛瘀药 神经根型颈椎病 META分析 系统评价 

分 类 号：R27[医药卫生—中医学]