健脾化痰类方治疗梅尼埃病疗效和安全性Meta分析
|
摘要
目的:系统评价健脾化痰类方治疗梅尼埃病的临床疗效和安全性。方法:通过检索知网、万方、CBM、维普、PubMed等数据库,检索时间从数据库建库至2018年5月;以及手工检索相关杂志和会议论文,收集关于健脾化痰类方治疗梅尼埃病的临床随机对照试验(RCT)。根据Cochrane系统评价和Jadad量表评价标准对纳入文献进行资料提取和质量评价后,采用Revman 5.3统计软件进行Meta分析。结果:最终纳入32篇文献,共计3175例患者,所纳入的文献均为中文文献。Meta分析结果显示:健脾化痰类方治疗梅尼埃病优势显著,与常规西药治疗对照组相比,临床总有效率合并效应值RR=1.22,95%CI=(1.18,1.26),差异有明显统计学意义;能明显改善眩晕症状,合并效应值RR=1.29,95%CI(1.14,1.45),差异有明显统计学意义;能明显改善听力下降症状,合并效应值RR=1.44,95%CI(1.19,1.75),差异有统计学意义;能降低不良反应事件的发生RR=0.25,95%CI(0.10,0.62),差异有统计学意义。结论:此次Meta分析表明,健脾化痰类方治疗梅尼埃病对比西药治疗有更好的临床疗效和安全性,或可在临床加以推广。本次研究纳入的文献质量不高,将来还需要更多规范的大样本、高质量的随机对照试验作为循证依据。
Objective: To evaluate the clinical efficacy and safety of invigorating spleen to resolving phlegm in the treatment of Meniere's disease. Methods:Databases such as CNKI,Wanfang Data,VIP,PubMed were searched up to May 2018. The relevant journals and conference papers were retrieved manually to collect the randomized controlled trial(RCT) about invigorating spleen to resolving phlegm in the treatment of Meniere's Disease. According to Cochrane system and Jadad scale, we evaluated the quality of literature and extracted the information and then analyzed by RevMan 5.3 software.Results:A total number of 32 pieces of literature involving 3175 patients, all of which were Chinese literature. The Meta-analysis results showed that invigorating spleen to resolving phlegm in the treatment of Meniere's disease has the significant advantages, compared with the treatment of western medicine control group. The total clinical efficience difference was statistically significant[RR=1.22,95%CI(1.18,1.26)]. It can significantly improve the symptoms of vertigo and hearing loss[RR=1.29,95%CI(1.14,1.45);RR=1.44,95%CI(1.19,1.75)] and the differences was statistically significant. Meanwhile,it can reduce the occurrence of adverse events[RR=0.25,95%CI(0.10,0.62)] and the differences was statistically significant. Conclusion: The Meta-analysis indicated that there were better efficacy and safety of invigorating spleen to resolving phlegm in the treatment of Meniere's disease compared with western medicine, or can be promoted in clinically. However,due to the low quality of the literature included in the study, a large samples and high quality randomized controlled trials are still needed as the clinical effectiveness evidence.
Objective: To evaluate the clinical efficacy and safety of invigorating spleen to resolving phlegm in the treatment of Meniere's disease. Methods:Databases such as CNKI,Wanfang Data,VIP,PubMed were searched up to May 2018. The relevant journals and conference papers were retrieved manually to collect the randomized controlled trial(RCT) about invigorating spleen to resolving phlegm in the treatment of Meniere's Disease. According to Cochrane system and Jadad scale, we evaluated the quality of literature and extracted the information and then analyzed by RevMan 5.3 software.Results:A total number of 32 pieces of literature involving 3175 patients, all of which were Chinese literature. The Meta-analysis results showed that invigorating spleen to resolving phlegm in the treatment of Meniere's disease has the significant advantages, compared with the treatment of western medicine control group. The total clinical efficience difference was statistically significant[RR=1.22,95%CI(1.18,1.26)]. It can significantly improve the symptoms of vertigo and hearing loss[RR=1.29,95%CI(1.14,1.45);RR=1.44,95%CI(1.19,1.75)] and the differences was statistically significant. Meanwhile,it can reduce the occurrence of adverse events[RR=0.25,95%CI(0.10,0.62)] and the differences was statistically significant. Conclusion: The Meta-analysis indicated that there were better efficacy and safety of invigorating spleen to resolving phlegm in the treatment of Meniere's disease compared with western medicine, or can be promoted in clinically. However,due to the low quality of the literature included in the study, a large samples and high quality randomized controlled trials are still needed as the clinical effectiveness evidence.
引文
[1] 贾建平.神经病学[M].北京:人民卫生出版社,2013:356.
[2] Jadad AR,Moore RA,Carroll D,et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary? [J].Control Clin Trials,1996,17(1):1-12.
[3] 俞阳.仙泽止眩汤治疗痰浊型美尼尔氏综合征50例临床疗效[J].宁夏医科大学学报,2016,38(7):851-852.
[4] 刘秀娟.加味半夏白术天麻汤联合针刺治疗梅尼埃病疗效观察[J].山西医药杂志,2012,41(1):74-75.
[5] 刘臣.柴陈泽泻汤治疗梅尼埃病随机平行对照研究[J].实用中医内科杂志,2013,27(5):15-17.
[6] 史彦顺.眩晕宁治疗梅尼埃病所致眩晕的疗效观察[J].中国社区医师,2010,12(34):124.
[7] 周山.熄风定眩汤治疗美尼尔氏综合征40例临床观察[J].新中医,2011,43(8):102-103.
[8] 安平祥,孙向毓.泽泻汤加味治疗梅尼埃病38例临床观察[J].西部中医药,2012,25(7):51-52.
[9] 岳希明.半夏白术天麻汤加味治疗美尼尔氏综合症效果观察[J].医学信息,2013,26(6):94.
[10] 张仲银.旋复代赭汤和半夏白术天麻汤治疗美尼尔病42例[J].光明中医,2010,25(7):1288-1289.
[11] 张川波.辨证治疗美尼尔氏综合征60例临床观察[J].湖南中医药导报,1997,3(2-3):52.
[12] 张虎,张大尉.加味温胆汤治疗梅尼埃病43例临床观察[J].首都医药,2013,3(下):50-51.
[13] 张靖,张应鹏.自拟涤眩汤治疗美尼尔氏综合症58例[J].中医临床研究,2014,6(25):74-75.
[14] 彭萍云.中药治疗美尼尔氏综合征45例临床观察[J].医学理论与实践,2011,24(20):2450-2451.
[15] 方向平,杨忠山.加味半夏白术天麻汤治疗梅尼埃病疗效观察[J].实用中医药杂志,2016,32(3):212-213.
[16] 朱文宗,金永喜,黄建平,等.豁痰健脾法治疗梅尼埃病的临床研究[J].浙江中医药大学学报,2012,36(11):1201-1204.
[17] 权正涛,侯彩霞.温胆汤加味治疗美尼尔氏症合症56例[J].职业与健康,2001,17(2):121.
[18] 李建超.半夏白术天麻汤加减治疗梅尼埃病46例分析[J].中国实用神经疾病杂,2009,12(5):93-94.
[19] 杜晓军,陈洪国.半夏白术天麻汤加味治疗美尼尔病60例[J].吉林中医药,2005,25(7):18.
[20] 杨圣俊,高辉,耿淑云,等.眩晕汤加减治疗梅尼埃病240例疗效观察[J].临床合理用药,2012,5(2A):72-73.
[21] 杨连.萸竹定眩汤加减治疗梅尼埃病34例[J].河南中医,2010,30(1):59-60.
[22] 段勇,汪琛琛.用五苓散(加减)治疗梅尼埃病的疗效观察[J].求医问药,2012,10(3):51.
[23] 涂三进,陈晓谦.加味半夏白术天麻汤治疗美尼尔氏病临床观察[J].湖北中医杂志,2006,28(6):37.
[24] 牛占海,刘永芹.降浊定眩汤治疗痰浊中阻型梅尼埃病48例[J].河北中医,2009,31(3):376-377.
[25] 王志敏.加减半夏白术天麻汤治疗梅尼埃病31例[J].浙江中医杂志,2009,44(1):34.
[26] 王聘益.加味苓桂术甘汤治疗梅尼埃病47例[J].河南中医,2013,33(2):182.
[27] 蔡凤信.化痰定眩汤治疗痰浊中阻型梅尼埃病60例[J].河北中医,2009,31(3):375-376.
[28] 谭英.三五七散合半夏白术天麻汤治疗内耳眩晕45例[J].湖南中医杂志,2009,25(1):38-39.
[29] 赵云华.加味半夏白术天麻汤治疗内耳性眩晕40例疗效观察[J].云南中医中药杂志,2003,24(4):21.
[30] 高云.祛痰止眩汤治疗痰湿壅盛型梅尼埃病疗效观察[J].河北中医,2012,34(8):1130-1131.
[31] 黄智斌.半夏白术天麻汤加味治疗美尼尔氏病临床观察[J].实用中医内科学,2012,26(1):95-96.
[32] 李士英.半夏白术天麻汤加味治疗(痰浊中阻型)梅尼埃病的临床疗效分析[J].中医临床研究,2017,9(15):60-61.
[33] 汪宁波,张鑫,张恩琴,等.半夏白术天麻汤治疗梅尼埃病的临床研究[J].中国中西医结合耳鼻咽喉科杂志,2016,24(3):211-213.
[34] 王昱,刘之旺.健脾化痰法治疗46例痰浊中阻型梅尼埃病患者回顾性研究[J].中医药学报,2010,38(5):123-124.
[2] Jadad AR,Moore RA,Carroll D,et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary? [J].Control Clin Trials,1996,17(1):1-12.
[3] 俞阳.仙泽止眩汤治疗痰浊型美尼尔氏综合征50例临床疗效[J].宁夏医科大学学报,2016,38(7):851-852.
[4] 刘秀娟.加味半夏白术天麻汤联合针刺治疗梅尼埃病疗效观察[J].山西医药杂志,2012,41(1):74-75.
[5] 刘臣.柴陈泽泻汤治疗梅尼埃病随机平行对照研究[J].实用中医内科杂志,2013,27(5):15-17.
[6] 史彦顺.眩晕宁治疗梅尼埃病所致眩晕的疗效观察[J].中国社区医师,2010,12(34):124.
[7] 周山.熄风定眩汤治疗美尼尔氏综合征40例临床观察[J].新中医,2011,43(8):102-103.
[8] 安平祥,孙向毓.泽泻汤加味治疗梅尼埃病38例临床观察[J].西部中医药,2012,25(7):51-52.
[9] 岳希明.半夏白术天麻汤加味治疗美尼尔氏综合症效果观察[J].医学信息,2013,26(6):94.
[10] 张仲银.旋复代赭汤和半夏白术天麻汤治疗美尼尔病42例[J].光明中医,2010,25(7):1288-1289.
[11] 张川波.辨证治疗美尼尔氏综合征60例临床观察[J].湖南中医药导报,1997,3(2-3):52.
[12] 张虎,张大尉.加味温胆汤治疗梅尼埃病43例临床观察[J].首都医药,2013,3(下):50-51.
[13] 张靖,张应鹏.自拟涤眩汤治疗美尼尔氏综合症58例[J].中医临床研究,2014,6(25):74-75.
[14] 彭萍云.中药治疗美尼尔氏综合征45例临床观察[J].医学理论与实践,2011,24(20):2450-2451.
[15] 方向平,杨忠山.加味半夏白术天麻汤治疗梅尼埃病疗效观察[J].实用中医药杂志,2016,32(3):212-213.
[16] 朱文宗,金永喜,黄建平,等.豁痰健脾法治疗梅尼埃病的临床研究[J].浙江中医药大学学报,2012,36(11):1201-1204.
[17] 权正涛,侯彩霞.温胆汤加味治疗美尼尔氏症合症56例[J].职业与健康,2001,17(2):121.
[18] 李建超.半夏白术天麻汤加减治疗梅尼埃病46例分析[J].中国实用神经疾病杂,2009,12(5):93-94.
[19] 杜晓军,陈洪国.半夏白术天麻汤加味治疗美尼尔病60例[J].吉林中医药,2005,25(7):18.
[20] 杨圣俊,高辉,耿淑云,等.眩晕汤加减治疗梅尼埃病240例疗效观察[J].临床合理用药,2012,5(2A):72-73.
[21] 杨连.萸竹定眩汤加减治疗梅尼埃病34例[J].河南中医,2010,30(1):59-60.
[22] 段勇,汪琛琛.用五苓散(加减)治疗梅尼埃病的疗效观察[J].求医问药,2012,10(3):51.
[23] 涂三进,陈晓谦.加味半夏白术天麻汤治疗美尼尔氏病临床观察[J].湖北中医杂志,2006,28(6):37.
[24] 牛占海,刘永芹.降浊定眩汤治疗痰浊中阻型梅尼埃病48例[J].河北中医,2009,31(3):376-377.
[25] 王志敏.加减半夏白术天麻汤治疗梅尼埃病31例[J].浙江中医杂志,2009,44(1):34.
[26] 王聘益.加味苓桂术甘汤治疗梅尼埃病47例[J].河南中医,2013,33(2):182.
[27] 蔡凤信.化痰定眩汤治疗痰浊中阻型梅尼埃病60例[J].河北中医,2009,31(3):375-376.
[28] 谭英.三五七散合半夏白术天麻汤治疗内耳眩晕45例[J].湖南中医杂志,2009,25(1):38-39.
[29] 赵云华.加味半夏白术天麻汤治疗内耳性眩晕40例疗效观察[J].云南中医中药杂志,2003,24(4):21.
[30] 高云.祛痰止眩汤治疗痰湿壅盛型梅尼埃病疗效观察[J].河北中医,2012,34(8):1130-1131.
[31] 黄智斌.半夏白术天麻汤加味治疗美尼尔氏病临床观察[J].实用中医内科学,2012,26(1):95-96.
[32] 李士英.半夏白术天麻汤加味治疗(痰浊中阻型)梅尼埃病的临床疗效分析[J].中医临床研究,2017,9(15):60-61.
[33] 汪宁波,张鑫,张恩琴,等.半夏白术天麻汤治疗梅尼埃病的临床研究[J].中国中西医结合耳鼻咽喉科杂志,2016,24(3):211-213.
[34] 王昱,刘之旺.健脾化痰法治疗46例痰浊中阻型梅尼埃病患者回顾性研究[J].中医药学报,2010,38(5):123-124.