中医方案治疗偏头痛的贝叶斯网状Meta分析  

Bayesian Network Meta-Analysis of TCM Therapies in the Treatment of Migraine

作　　者：付勇[1] 董志威 周旭[3] 李琳慧 刘慧[1] 喻文 廖璐 章海凤[1] Fu Yong;Dong Zhiwei;Zhou Xu;Li Linhui;Liu Hui;Yu Wen;Liao Lu;Zhang Haifeng(The Affiliated Hospital of Jiangxi University of CM,Nanchang 330006,China;The Graduate School of Jiangxi University of Chinese Medicine,Nanchang 330004,China;The Centre of Evidence-based Medicine of Jiangxi University of Chinese Medicine,Nanchang 330004,China)

机构地区：[1]江西中医药大学附属医院,南昌3330006 [2]江西中医药大学研究生院,南昌3330004 [3]江西中医药大学循证医学中心,南昌3330004

出　　处：《世界科学技术-中医药现代化》2022年第11期4325-4338,共14页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：国家科学技术部重点研发计划中医药现代化研究重点专项(2019YFC1709703):“宣阳解郁,通络止痛”针药结合方案的循证评价及方案优化研究,负责人:付勇。

摘　　要：目的 运用贝叶斯网状Meta分析法比较中药、针灸推拿等中医方案对偏头痛患者5-HT、头痛发作频率、VAS评分及有效率的疗效差异性。方法 计算机检索中英文八大数据库,收集中药方剂、针灸推拿等干预偏头痛的随机对照试验,检索时间为建库-2021年12月,评价文献质量,运用Stata和Gemtc软件分析数据。结果 纳入42篇文献,网状Meta分析结果显示,在对5-HT影响上,与西药相比,单纯中药或针刺、针刺+中药方案疗效均显著,其中针刺+中药的治疗方案升高偏头痛患者5-HT效果最优[SMD=2.02%,95%CI(0.86,3.18),P<0.01],其次为针刺[SMD=1.99%,95%CI(0.81,3.16),P<0.01],再次为中药[SMD=1.60%,95%CI(0.82,2.39),P<0.001],疗效排序依次为推拿+中药>针刺+中药>针刺>中药>推拿>灸法>西药。在降低头痛发作频率上,针刺+中药的治疗方案效果最优[MD=-11.55,95%CI(-15.36,-7.74),P<0.001],其次为推拿+中药[MD=-9.05,95%CI(-14.37,-3.73),P<0.01],排序评价依次为针刺+中药>推拿+中药>针刺+推拿>推拿>中药>针刺>灸法>西药。在降低VAS评分上,单纯中药或针刺、灸法、针刺+中药以及针刺+推拿方案疗效均显著,针刺+推拿治疗方案降低偏头痛患者VAS评分最优[MD=-1.74,95%CI(-3.12,-0.37),P<0.01],其次为针刺+中药[MD=-1.72,95%CI(-2.52,-0.92),P<0.01],再次为单纯中药[MD=-1.53,95%CI(-2.11,-0.94),P<0.05],灸法[MD=-1.27,95%CI(-2.27,-0.27),P<0.05],单纯针刺[MD=-1.03,95%CI(-1.72,-0.34),P<0.05],疗效排序依次为针刺+推拿>针刺+中药>中药>灸法>针刺>推拿+中药>推拿>西药。有效率上,单纯中药、灸法、针刺+中药、针刺+推拿以及推拿+中药方案疗效均显著,推拿+中药方案有效率最高[MD=6.48,95%CI(2.66,15.81),P<0.001],其次为针刺+中药[MD=5.32,95%CI(2.62,10.83),P<0.01],再次为单纯中药[MD=4.74,95%CI(3.14,7.15),P<0.001],灸法[MD=3.71,95%CI(1.76,7.84),P=0.012],针刺+推拿[MD=3.49,95%CI(1.47,8.28),P<0.01],排序评价依次为推拿+中药>针刺+中药>中�Objective To compare the efficacy variability TCM therapies(Chinese herbs, acupuncture, tuina and so on)on 5-HT, headache attack frequency, VAS score and effective rate in migraine patients using Bayesian Meta-analysis.Methods Computer search of eight databases in English and Chinese to collect randomized controlled trials of TCM interventions such as Chinese herbal prescriptions, acupuncture and tuina for migraine was conducted from the time of database construction to December 2021, to evaluate the quality of the literature, and to analyze the data using Stata and Gemtc. Results 42 studies were included, In terms of the effect on 5-HT, the efficacy of herbal medicine alone or acupuncture and acupuncture plus herbal medicine regimens were all significant compared to western medicine, with the treatment regimen of acupuncture plus herbal medicine having the best effect in elevating 5-HT in migraine patients [SMD=2.02%, 95% CI(0.86, 3.18), P<0.01], followed by acupuncture [SMD=1.99%, 95 % CI(0.81, 3.16), P<0.01],followed by Chinese herbal medicine [SMD=1.60%, 95% CI(0.82, 2.39), P<0.001], and the order of efficacy was Tuina plus Chinese herbal medicine > acupuncture + Chinese herbal medicine > acupuncture > Chinese herbal medicine >Tuina > moxibustion > western medicine. In terms of reducing the frequency of headache attacks, the treatment protocol of acupuncture plus herbal medicine was the most effective [MD=-11.55, 95% CI(-15.36,-7.74), P<0.001], followed by Tuina plus herbal medicine [MD=-9.05, 95% CI(-14.37,-3.73), P<0.01], and the ranking evaluation was in the order of acupuncture+herbal medicine > Tuina plus herbal medicine > acupuncture plus Tuina > Tuina > herbal medicine > acupuncture > moxibustion > western medicine.In terms of reducing VAS scores, the efficacy of acupuncture alone or acupuncture, moxibustion, acupuncture plus herbal medicine and acupuncture + Tuina regimens were all significant, with the acupuncture plus Tuina regimen being the most effective in reducing VAS scores in migraine patients

关 键 词：中医方案 偏头痛 随机对照试验 贝叶斯网状Meta分析 

分 类 号：R-058[医药卫生]