文献类型：学位论文

中文题名：平肝熄风法治疗小儿多发性抽动症随机对照试验的meta分析

英文题名：A Meta-analysis of Randomized Controlled Trials on Calming the Liver to Stop the Wind Treatment Tourette's Syndrome in Children

作者：闫娟[1];

第一作者：闫娟

机构：[1]甘肃中医学院;

第一机构：甘肃中医药大学

导师：史正刚;甘肃中医学院

授予学位：硕士

语种：中文

中文关键词：中医;平肝熄风;小儿多发性抽动症;抽动—秽语综合症;随机对照试验;meta分析

外文关键词：Tourette’s syndrome;calming the liver to stop the wind;randomized controlled trial;meta analysis

年份：2014

摘要：目的：利用循证方法评价平肝熄风法治疗小儿多发性抽动症的疗效，为临床实践提供证据。 方法：以平肝熄风、小儿多发性抽动症、抽动—秽语综合症、中医、中药、中西医结合等词制定检索策略，检索中文期刊网全文数据库（CNKI）、中国生物医学文献光盘数据库（CMB disc）、中国优秀博硕士学位论文全文数据库（CDMD）、万方数据库、PubMed数据库、Cochrane library。由两名评价者进行独立检索和文献的筛选，当意见有分歧时经讨论解决，对纳入文献按照Jadad评分量表进行评价和提取数据。Meta分析采用Cochrane协作网上下载的ReviewManager5.1软件进行数据的统计分析，计数资料用OR或RR及其95%CI作为效应量，数值变量使用SMD或WMD及其95%CI作为统计分析效应量，并通过变换统计效应量以及效应模型的方式进行敏感性分析和绘制漏斗图进行偏倚分析。 结果： ⑴资料情况：共纳入8篇文献，全部为中文，纳入病例565例，其中中医平肝熄风法治疗组306例，西医西药治疗对照组259例。纳入文献中二篇Jadad评分为1分、其余文献均为2分，纳入的文献中都明确指出了基线均衡，具有可比性。2篇文章提到使用随机数字表，3篇文章使用就诊顺序随机分组，其余3篇文章只提到随机分组，但并未描述随机序列的产生方法。8篇文献均未描述随机分配方案的隐藏，仅有1篇文献报告了退出病例，均未进行意向性分析，其余均未交代其退出和失访。 ⑵meta分析结果：平肝熄风法方药治疗小儿多发性抽动症在有效率方面（随机效应模型：WMD=1.23，95%CI;1.12，1.35，P＜0.00001）、复发率方面（随机效应模型：WMD=0.47，95%CI;0.30，0.74，P=0.001）、不良反应方面（随机效应模型：WMD=0.04，95%CI;0.01，0.18，P＜0.0001）优于西医治疗，且差异具有显著性意义。 结论：运用中医辨证，使用平肝熄风方药治疗小儿多发性抽动症有效性显著。
Objectives: Evidence-based medicine approach is applied to evaluate the efficacy ofthe calming the liver to stop the wind treatment Tourette’s syndrome in children. Thispaper aims to figure out the role that the calming the liver to stop the wind treatmentof TCM syndrome plays in the treatment of Tourette’s syndrome in children, find thebest treatment options and improve the clinical efficacy of Tourette’s syndrome inchildren. Methods: Retrieval strategy using Tourette’s syndrome in children、 chinesemedicine、calming the liver to stop the wind. By searching the China NationalKnowledge Infrastructure /(CNKI/), Chinese Biomedical Literature Database /(CMBdisc/), Chinese Selected Doctoral Dissertations and Master’s Theses Full-TextDatabases/(CDMD/), Wanfang Data, PubMed Data and Cochrane library. Thesearching is carried out independently by two reviewers, the quality assessment anddata extraction should be based on their agreement according to the Jadad scoringscale. The Review Manager5.1software provided by Cochrane Network is adoptedfor meta analysis. OR or RR and its95/%CI are used as effect quantity when counting.The numerical variables SMD OR WMD and its95/%CI are applied as statisticalanalysis effect quantity. Thus, bias analysis could be concluded by the sensitivityanalysis and funnel diagram of changing the effect quantity and effect model. Result：The techniques and academic schools of Chinese manipulative therapy havegreatly increased recently and disordered. Standardize the classification andnomenclature of Chinese manipulative techniques is an essential task to be carried outas soon as possible. Conclusion:1.Background Information:8of articles published in china werecollected,the content of which cover565cases,including259cases of westernmedicine and306cases traditional chinese. Scores of all articls were evaluated byJadad standard.Among them, two article is scored2points, and the rest below1points. To compare difference between them,all articles studied are strictly evaluatedand the balance baseline. The method of grouping are various, of which2articles userandom number tables,3articles semi-randomized odd even method of hospitalnumber, and the rest3articles only mentioned randomization with no detaileddescription. None article adopted suitable blind method and only one article raised theexit and lost cases. 2.The meta analysis result: The combination of both the Chinese medicine groupis superior to the western medicine group in the efficient:/(random effects model:WMD=1.19，95/%CI；1.10，1.30，P＜0.00001/), the recurrence rate /(random effectsmodel: WMD=0.47，95/%CI；0.30，0.74，P=0.001，P＜0.00001/), and the adversereaction /(random effects model: WMD=0.04，95/%CI；0.01，0.18，P＜0.0001/). Conclusion: The results of meta analysis of the8Randomized controlled trials showthat the efficient,the recurrence rate and the adverse reaction of calming the liver tostop the wind treatment of TS exceeds that of merely applying the modern sciencetherapy.