针药结合治疗腰椎管狭窄症有效性和安全性的meta分析

杨琳琳; 王颜; 袁海光; 鱼博强; 何英涛

doi:10.16766/j.cnki.issn.1674-4152.004470

针药结合治疗腰椎管狭窄症有效性和安全性的meta分析

doi: 10.16766/j.cnki.issn.1674-4152.004470

杨琳琳^{1, 2},
王颜^1, ,,
袁海光²,
鱼博强²,
何英涛²

1.
西安国际医学中心医院儿童康复二科, 陕西西安 710100
2.
陕西中医药大学针灸推拿学院, 陕西咸阳 712046

基金项目:

全国中医药研究生教育研究课题 YJS-YB-2023-40

陕西中医药大学研究生教育教学改革创新项目 JGCX202303

详细信息

通讯作者:
王颜，E-mail：429034581@qq.com

中图分类号: R681.53
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出版历程
- 收稿日期: 2025-05-22

Efficacy analysis of acupuncture combined with medicine in the adjuvant treatment of lumbar spinal stenosis: a meta-analysis

1.
Department of Pediatric Rehabilitation Ⅱ, Xi'an International Medical Center Hospital, Xi'an, Shaanxi 710100, China

摘要

摘要: 目的针药结合治疗腰椎管狭窄症的相关报道日益增加，但目前尚无相关系统评价，现基于循证医学的meta方法对针药结合治疗腰椎管狭窄症的有效性和安全性进行评价。方法系统检索中国知网、万方数据知识服务平台、维普中文科技期刊数据库、中国生物医学文献库、Cochrane Library、PubMed、Embase、Web of Science数据库中有关针药结合治疗腰椎管狭窄症的随机对照试验文献，检索时间从建库至2023年9月。由2名研究者独立收集文献, 提取数据，并进行质量评价，完成后采用RevMan 5.4软件进行meta分析。结果共纳入14篇文献, 涉及990例患者。meta分析结果显示: 2组疼痛评分(SMD=-1.63, 95% CI：-2.16~-1.09)、腰椎功能状况评分(SMD=1.58, 95% CI：0.81~2.35)、血清炎性因子IL-1α含量(MD=-2.70, 95% CI: -3.68~-1.73)、血清炎性因子TNF-α含量(MD=-5.27, 95% CI: -7.62~-2.93)、有效率(OR=3.47，95% CI: 1.86~6.48)比较，观察组均优于对照组。结论针药结合治疗能提高腰椎管狭窄症的临床疗效，不良事件发生少，安全性较好。
- 腰椎管狭窄症 /
- 针药结合 /
- meta分析
Abstract: Objective The reports on the use of acupuncture combined with medicine for the treatment of lumbar spinal stenosis have been increasing. However, no relevant systematic evaluation is currently available. Based on the meta-analytic methods of evidence-based medicine, this study evaluates the efficacy and safety of acupuncture combined with medicine in the treatment of lumbar spinal stenosis. Methods A computerized search for randomized controlled trials on acupuncture combined with medicine for lumbar spinal stenosis was conducted in CNKI, Wanfang Data, VIP, SinoMed, Cochrane Library, PubMed, Embase, and Web of Science from inception to September 2023. Two researchers independently collected the literature, and meta-analysis was performed using RevMan 5.4 software following initial and subsequent screening. Results A total of 14 papers involving 990 patients were included. The results of the meta-analysis showed that, compared with the control group, the observation group demonstrated significantly better outcomes in pain score (SMD=-1.63, 95% CI: -2.16 to -1.09), the lumbar function score (SMD=1.58, 95% CI: 0.81 to 2.35), the serum inflammatory factor IL-1ɑ content (MD=-2.70, 95% CI: -3.68 to -1.73), the serum inflammatory factor TNF-α content (MD=-5.27, 95% CI: -7.62 to -2.93), and overall effective rate (OR=3.47, 95% CI: 1.86 to 6.48). Conclusion The combination of acupuncture and medicine can improve the clinical efficacy of lumbar spinal stenosis, with fewer adverse events and better safety.
- Lumbar spinal stenosis /
- Acupuncture combined with medicine /
- Meta-analysis
利益冲突 无

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图 1 文献筛选流程

Figure 1. Literature screening flowchart

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图 2 风险偏倚评估汇总

Figure 2. Summary of risk of bias assessment

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图 3 2组患者疼痛程度评分比较森林图

Figure 3. Forest plot of pain intensity score comparison between two groups of patients

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图 4 组患者腰椎功能状况评分比较森林图

Figure 4. Forest plot of lumbar function score comparison between two groups of patients

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图 5 2组患者血清炎性因子IL-1α比较森林图

Figure 5. Forest plot of serum inflammatory factor IL-1α comparison between two groups of patients

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图 6 2组患者血清炎性因子TNF-α比较森林图

Figure 6. Forest plot of serum inflammatory factor TNF-α comparison between two groups of patients

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图 7 2组患者有效率比较森林图

Figure 7. Forest plot of effective rate comparison between two groups of patients

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图 8 发表偏倚的Begg’ s检验

Figure 8. Begg's test for publication bias

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图 9 2组患者不良反应发生率比较森林图

Figure 9. Forest plot of adverse reaction rate comparison between two groups of patients

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表 1 纳入文献基本特征

Table 1. Basic characteristics of included studies

作者及年份	总样本量(T/C)	性别(男性/女性，例)	疗程	干预措施		随机方法	盲法	分配隐藏	基线情况
作者及年份	总样本量(T/C)	性别(男性/女性，例)	疗程	治疗组	对照组	随机方法	盲法	分配隐藏	基线情况
陈祝江等2019	31/31	38/24	2周	电针+甲钴胺	甲钴胺	随机数字表	不清楚	不清楚	基线可比
冯雪等2019	40/40	53/27	1个月	哌拉西林钠他唑巴坦钠	哌拉西林钠他唑巴坦钠	未提及	不清楚	不清楚	基线可比
高帅2018	44/44	48/40	2周	电针+补阳还五汤	补阳还五汤	随机数字表	不清楚	不清楚	基线可比
黄正等2017	32/31	34/29	3个月	电针+补阳还五汤	补阳还五汤	随机数字表	不清楚	不清楚	基线可比
雷小平2020	34/34	35/33	1个月	针刺+独活寄生汤	甲钴胺	提及但未描述	不清楚	不清楚	基线可比
李永强等2018	34/34	28/40	2周	电针+依托考昔片	依托考昔片	提及但未描述	不清楚	不清楚	基线可比
刘国军2016	41/37	45/33	4周	针刺+补阳还五汤	补阳还五汤	随机数字表	不清楚	不清楚	基线可比
刘陆伟2018	40/40	52/28	4周	针刺+前列地尔	前列地尔	随机数字表	不清楚	不清楚	基线可比
刘郁林等2022	31/31	34/28	1周	电针+塞来昔布	塞来昔布	随机数字表	不清楚	不清楚	基线可比
苏必良等2020	40/40	45/35	3个月	电针+红冰止痛酊	红冰止痛酊	随机数字表	不清楚	不清楚	基线可比
孙莉2008	20/15	14/21	20 d	针刺+消刺散	消刺散	提及但未描述	不清楚	不清楚	基线可比
王刚强2017	25/25	29/21	10 d	电针+神经妥乐平	神经妥乐平	根据不同治疗方式分配	不清楚	不清楚	基线可比
禤品莲2022	46/40	48/38	1周	电针+哌拉西林钠他唑巴坦钠	哌拉西林钠他唑巴坦钠	随机数字表	不清楚	不清楚	基线可比
王吉庆2023	30/30	27/33	1个月	电针+补阳还五汤	补阳还五汤	软件随机分配	不清楚	不清楚	基线可比

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