针刺干预偏头痛优势方案构建研究:基于熵权TOPSIS法  

Construction of Optimized Treatment Plan of Acupuncture for Migraine Based on Entropy Weight-TOPSIS Method

作　　者：王喆 董志浩 郑好 孔文程 张玉宽 张秋月 韩晶[3] WANG Zhe;DONG Zhihao;ZHENG Hao;KONG Wencheng;ZHANG Yukuan;ZHANG Qiuyue;HAN Jing(Institute of Acumox and Tuina,Shandong University of Traditional Chinese Medicine,Jinan 250013,China;Central Hospital Affiliated to Shandong First Medical University,Jinan 250013,China;Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250013,China)

机构地区：[1]山东中医药大学针灸推拿学院,山东省济南市250013 [2]山东第一医科大学附属中心医院,山东省济南市250013 [3]山东中医药大学附属医院,山东省济南市250013

出　　处：《中国全科医学》2023年第34期4336-4342,4350,共8页Chinese General Practice

基　　金：国家自然科学基金青年科学基金资助项目(81503502);山东省自然科学基金面上项目(ZR2020MH365)。

摘　　要：背景 随着高质量循证医学证据的积累,针刺治疗偏头痛的临床有效性逐渐得到认可。目前国内有相当数量的针灸临床研究通过临床试验的方法而突出、验证各种针刺干预方案的优势,通过整合、筛选其中的优势方案而指导临床实践已成为针灸研究的新方向。目的 运用基于Meta分析的熵权逼近理想解排序(TOPSIS)法进行多指标决策(MCDM),从多维度筛选偏头痛针刺干预优势方案,对针刺干预优势方案构建思路进行探索。方法 计算机检索万方数据知识服务平台、维普网、中国知网、中国生物医学文献数据库、PubMed、Web of Science、EmBase中2022年4月以前发表的针刺治疗偏头痛的随机对照试验(RCT),由2名研究者分别独立筛选文献、提取文献基本特征[作者、发表年份、样本量、治愈率、有效率和视觉模拟评分(VAS)等],并运用改良Jadad评分对RCT进行质量评价。根据纳入RCT的特点归纳偏头痛针刺干预方案,并对不同方案进行Meta分析。根据Meta分析结果提取各方案的治愈率、有效率的相对危险度(RR)和VAS的平均差(MD),并以每项研究样本量为权重计算各方案的治疗次数、改良Jadad评分的加权平均值,共同纳入MCDM分析,并采用熵权法确定不同决策指标的权重,最终运用TOPSIS法对偏头痛针刺干预优势方案进行筛选。结果 共纳入17项RCT,根据Meta分析结果归纳为8种偏头痛针刺干预方案(通元针法、治神六穴、骨边刺、常规针刺、胆经腧穴、头部腧穴、透刺法、四关穴)。各方案TOPSIS法最终评价结果显示,以头部腧穴为主的针刺干预方案最佳,该优势方案针刺头部腧穴以风府、头维、头临泣、太阳、率谷、风池为主,每日或隔日1次,平均治疗次数为11次,其主要优势在于治疗时间短、VAS降低明显。结论 本研究所筛选构建的偏头痛针刺干预优势方案可为临床应用提供参考,基于Meta分析的熵权TOPBackground With the accumulation of high-quality evidence,the clinical effectiveness of acupuncture for migraine has been increasingly recognized.Numerous acupuncture clinical studies in China highlight and validate various acupuncture intervention schemes through clinical trials.Integrating and selecting these advantageous schemes to guide clinical practice has become a new focus in acupuncture research.Objective To conduct multicriteria decision making(MCDM)by using technique for order preference by similarity to an ideal solution(TOPSIS)method based on Meta-analysis,screen optimized treatment plan(OTP)of acupuncture for migraine and explore the ideas for constructing OTPs of acupuncture.Methods Wanfang Data,VIP,CNKI,SinoMed,PubMed,Web of Science,and EmBase were searched by computer for randomized controlled trials(RCTs)on acupuncture treatment for migraine published before April 2022.Two researchers independently screened the literature,extracted basic characteristics of literature[author,year of publication,sample size,cure rate,efficiency rate and visual analogue score(VAS),etc.],and assessed the quality of the RCTs by using modified Jadad scale.Acupuncture treatment plans for migraine were summarized based on the characteristics of the included RCTs,and Meta-analysis was performed.The relative risk(RR)of cure rate and efficiency rate,and the mean difference(MD)of VAS scores for each plan were extracted based on the Meta-analysis results.The treatment frequency and score of the modified Jadad scale were calculated for each plan using sample size as the weight.The data were all included in the MCDM analysis,the weights of different decision criterion were determined using the entropy weight method.The TOPSIS method was finally used to select OTP of acupuncture for migraine.Results A total of 17 RCTs were included and categorized into 8 types of treatment plans of acupuncture for migraine(Tongyuan acupuncture,six-spirit points,bone-nearby acupuncture,conventional acupuncture,Gallbladder Meridian acupoints,head

关 键 词：偏头痛 针刺 优势方案 多指标决策 逼近理想解排序 META分析 

分 类 号：R747.2[医药卫生—神经病学与精神病学]