艾灸治疗桥本甲状腺炎的系统评价和荟萃分析  

Moxibustion for Hashimotos Throiditis: A Systematic Review and Meta-Analysis

作　　者：刘雅楠[1] 赵继梦[1] 朱美玲[2] 吴焕淦[1] 纪军 常小荣[3] 胡玲[4] 赵百孝[5] 郑寒丹 景华 吴璐一[7] Liu Yanan;Zhao Jimeng;Zhu Meiling;Wu Huangan;Ji Jun;Chang Xiaorong;Hu Ling;Zhao Baixiao;Zheng Handan;Jing Hua;Wu Luyi(Yueyang Hospital o f Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;Bao'an District Chinese Medicine Hospital,Shenzhen 518133,China;School of Acupuncture-Moxibustion and Tuina,Hunan University of Chinese Medicine,Changsha 410208,China;School of Acupuncture-Moxibustion and Tuina,Anhui University of Chinese Medicine,Hefei 230038,China;School of Acupuncture-Moxibustion and Tuina,Beijing University of Chinese Medicine,Beijing 100029,China;Naval Specialty Medical Center,Shanghai 200052,China;Key Laboratory of Acupuncture-Moxibustion and Immunological Effects,Shanghai University of Traditional Chinese Medicine,Shanghai 200030,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院,上海200437 [2]深圳市宝安区中医院,深圳518133 [3]湖南中医药大学针灸推拿学院,长沙410208 [4]安徽中医药大学针灸推拿学院,合肥230038 [5]北京中医药大学针灸推拿学院,北京100029 [6]海军特色医疗中心,上海200052 [7]上海中医药大学针灸免疫效应重点研究室,上海200030

出　　处：《世界科学技术-中医药现代化》2019年第8期1573-1582,共10页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：国家科技部重点基础研究发展计划“973计划”项目（2015CB554501）：艾灸效应的启动机制及其内源性调节作用的机理研究，负责人：吴焕淦;国家科技部重点基础研究发展计划“973计划”项目（2009CB522900）：灸法作用的基本原理与应用规律研究，负责人：吴焕淦;国家自然科学基金委员会资助项目（81704176）：基于small RNA-seq的针灸治疗桥本甲状腺炎的免疫调控机制研究，负责人：赵继梦;上海市卫生和计划生育委员会中医药科研专项课题（2016LQ013）：隔附子饼灸治疗桥本甲状腺炎的疗效评价及推广应用，负责人：赵继梦

摘　　要：目的系统评价艾灸治疗桥本甲状腺炎的疗效。方法分别在CNKI、VIP、万方、CBM、PubMed、Medline、Embase、Cochrane Library数据库检索以艾灸为主要干预措施治疗桥本甲状腺炎的随机对照试验。检索结束后,由2位研究者独立进行文献筛选、资料提取,数据整合,并根据Cochrane手册对纳入文献进行偏倚风险评估,然后采用RevMan5.3软件进行Meta分析。结果对文献筛选后最终纳入7个RCTs,共537名患者,艾灸治疗方法主要为隔药饼灸。分析结果显示,隔药饼灸在改善抗甲状腺球蛋白抗体(Thyroglobulin antibody,TGA)和抗甲状腺微粒抗体(Microsomal antibody,MCA)水平上优于西药治疗(P<0.01)。在总有效率上,隔药饼灸加西药治疗的疗效并不优于单纯西药治疗;甲状腺激素水平的改善上,隔药饼灸结合西药对FT3、FT4的改善也不优于单纯西药治疗,但对于TSH水平的改善优于单纯西药治疗(P<0.01)。结论隔药饼灸在改善桥本甲状腺炎自身抗体水平方面较常规西药治疗有一定的优势;隔药饼灸结合西药还可明显改善TSH水平,但在总有效率及FT3、FT4的改善上与单纯西药比无优势。由于纳入文献质量的限制,现有的研究还不足以有充分的证据来证实隔药饼灸的疗效,可能还需设计严谨的大样本、高质量临床试验研究进行验证。Objective To evaluated the efficacy of moxibustion treatment for Hashimoto. s thyroiditis(HT). MethodsDatabases of CNKI, VIP, Wan Fang, CBM, Pub Med, Medline, Embase, Cochrane Library were searched for RCTs wheremoxibustion was the main intervention for Hashimoto. s thyroiditis. After the search, two investigators independentlyperformed literature screening, data extraction, data integration, and assessed the risk of bias of included literaturesaccording to the Cochrane Handbook, then a meta-analysis was performed by using Rev Man5.3 software. Results A total of 7 RCTs involving 537 patients were included and herb-partitioned moxibustion was the main moxibustion method.The results of meta-analysis showed that the herb-partitioned moxibustion was superior to western medicine inimproving the levels of anti-thyroglobulin antibody(TGA) and anti-thyroid microsomal antibody(MCA)(P < 0.01). Interms of total effective rate, the efficacy of herb-partitioned moxibustion plus western medicine was not better thanwestern medicine;in terms of thyroid function, the improvement of FT3 and FT4 levels by herb-partitioned moxibustionplus western medicine were also not better than western medicine, but was superior to western medicine in theimprovement of TSH level(P < 0.01). Conclusion Herb-partitioned moxibustion has certain advantages in improving theautoantibody levels of HT compared with the conventional western medicine, and the combination of herb-partitionedmoxibustion and western medicine can also significantly improve the TSH level compare with western medicine, but notthe total effective rate and FT3, FT4 levels. Due to the limitation of quality of included studies, the existing researchesare not enough to have sufficient evidence to confirm the efficacy of the herb-partitioned moxibustion, and rigorousdesign of large sample, high quality clinical studies are needed for further verification.

关 键 词：艾灸 桥本甲状腺炎 系统评价 荟萃分析 

分 类 号：F1246[经济管理—世界经济]