推拿治疗儿童腺样体肥大的有效性meta分析

任艳; 陈克诚; 杨润; 元媛

doi:10.16766/j.cnki.issn.1674-4152.004519

推拿治疗儿童腺样体肥大的有效性meta分析

doi: 10.16766/j.cnki.issn.1674-4152.004519

任艳^{1, 2},
陈克诚^{3, 4},
杨润^5, ,,
元媛^{1, 2}

1.
中国中医科学院西苑医院山西医院推拿一科，山西太原 030024
2.
山西中医药大学附属医院推拿一科，山西太原 030024
3.
中国中医科学院西苑医院山西医院推拿二科
4.
山西中医药大学附属医院推拿二科
5.
晋中市中医院，山西晋中 030000

基金项目:

山西省中医药管理局科研课题 2024ZYY2A007

详细信息

通讯作者:
杨润，E-mail：1956332001@qq.com

中图分类号: R766.3 R244.1
计量
- 文章访问数: 10
- HTML全文浏览量: 7
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2025-09-24
- 网络出版日期: 2026-11-10

Meta-analysis of Tuina Therapy for pediatric adenoid hypertrophy

REN Yan^{1, 2},
CHEN Kecheng^{3, 4},
YANG Run^{5
, ,},
YUAN Yuan^{1, 2}

1.
Tuina Department 1, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Shanxi Hospital, Taiyuan, Shanxi 030024, China

摘要

摘要: 目的系统评价推拿治疗儿童腺样体肥大的有效性，为指导临床采用推拿治疗该病提供科学依据。方法计算机检索中国知网、万方、维普、CBM、PubMed、Cochrane Library、EMbase、Web of Science数据库关于推拿治疗儿童腺样体肥大的随机对照研究，检索时限为各数据库建库至2024年11月，语种限定为中文和英文。首先对各数据库检出的文献应用NoteExpress软件分析，剔除重复文献。然后由2名工作人员按照文献纳入和排除标准进一步筛选，并对最终纳入文献的研究数据进行提取。分别应用Cochrane系统和RevMan 5.3软件对纳入文献的质量和数据进行meta分析。结果共获取相关文献131篇，经严格筛选最终纳入13篇文献，共1 036例患儿。Meta分析结果显示，推拿组治疗儿童腺样体肥大的临床总有效率更高(OR=5.43，95% CI：3.50~8.42，P＜0.001)，症状总积分(MD=-3.92，95% CI：-5.61~-2.23，P＜0.001)、鼻塞症状积分(MD=-0.91，95% CI：-1.23~-0.59)，P＜0.001)、打鼾症状积分(MD=-0.97，95% CI：-1.36~-0.58)，P＜0.001)、张口呼吸症状积分(MD=-1.02，95% CI：-1.41~-0.63，P＜0.001)更低，腺样体A/N值结果更低(MD=-0.03，95% CI：-0.06~-0.00，P=0.03)，生活质量评分更低(MD=-8.38，95% CI：-10.00~-6.77，P＜0.001)。结论推拿组治疗儿童腺样体肥大疗效肯定，且明显优于对照组，可提高临床疗效。但受纳入研究样本量及质量的限制，后续仍需更多大样本、高质量的临床研究来验证其效果。
- 腺样体肥大 /
- 推拿 /
- 随机对照试验 /
- Meta分析
Abstract: Objective To systematically evaluate the effectiveness of Tuina therapy in treating adenoid hypertrophy in children, provide scientific evidence for guiding the use of Tuina in treating the disease. Methods Randomized controlled trials on Tuina therapy for adenoid hypertrophy in children were retrieved from CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, EMbase, and Web of Science databases from their establishment to November, 2024. The language was limited to Chinese and English. Firstly, the literature identified from various databases was analyzed using NoteExpress software to eliminate duplicate documents. Subsequently, two staff members further screened the documents according to the inclusion and exclusion criteria and extracted the research data from the ultimately included studies. The quality and data of the included literature were then subjected to Meta-analysis using the Cochrane system and RevMan 5.3 software. Results A total of 131 relevant articles was obtained. After strict screening, 13 studies involving 1 036 children were included. The meta-analysis results showed that the overall clinical effective rate of the Tuina group was higher (OR=5.43, 95% CI: 3.50-8.42, P < 0.001), the total score of TCM syndromes (MD=-3.92, 95% CI: -5.61 to -2.23, P < 0.001), the score of nasal congestion symptoms (MD=-0.91, 95% CI: -1.23 to -0.59, P < 0.001), the score of snoring symptoms (MD=-0.97, 95% CI: -1.36 to -0.58, P < 0.001), the score of mouth breathing symptoms (MD=-1.02, 95% CI: -1.41 to -0.63, P < 0.001), the A/N value of adenoids (MD=-0.03, 95% CI: -0.06 to -0.00, P=0.03), and the quality of life score (MD=-8.38, 95% CI: -10.00 to -6.77, P < 0.001) were all lower. Conclusion The therapeutic effect of Tuina on children with adenoid hypertrophy is definite and significantly better than that of the control group, which can improve the clinical efficacy. However, due to the limitations of the sample size and quality of the included studies, more large-sample and high-quality clinical studies are still needed to verify its effect in the future.
- Adenoid hypertrophy /
- Tuina /
- Randomized controlled trial /
- Meta-analysis

HTML全文

图 1 13篇纳入文献偏倚风险分析图

Figure 1. Risk of bias analysis for the 13 included studies

下载: 全尺寸图片幻灯片

图 2 推拿治疗腺样体肥大总有效率比较的meta分析森林图

Figure 2. Forest plot of meta-analysis comparing the overall effective rate of tuina therapy for adenoid hypertrophy

下载: 全尺寸图片幻灯片

图 3 推拿治疗腺样体肥大关于症状总积分及鼻塞、打鼾、张口呼吸症状积分比较的meta分析森林图

Figure 3. Forest plot of meta-analysis comparing the total symptom scores and scores for nasal congestion, snoring, and mouth breathing symptoms in the treatment of adenoid hypertrophy with Tuina Therapy

下载: 全尺寸图片幻灯片

表 1 纳入文献的基本特征

Table 1. Basic characteristics of the included studies

纳入文献	例数		治疗措施		总疗程	结局指标	随访	证型	脱落退出
纳入文献	T	C	T	C	总疗程	结局指标	随访	证型	T	C
王赛娜2018	30	28	推拿+糠酸莫米松鼻喷雾剂	糠酸莫米松鼻喷剂	4周	①④	未提及	无	0	2
姜之炎2018	30	30	推拿+运脾化痰通窍方	辛芩颗粒	2个月	①②③	未提及	脾虚痰阻证	无	无
刘鲲鹏2021	30	30	推拿	糠酸莫米松鼻喷剂	4周	①②③④	未提及	无	无	无
刘俊俊2021	30	30	推拿+内服散结化痰缩腺方	孟鲁司特钠	2个月	①②	未提及	无	无	无
邵梦洁2021	22	20	推拿+自拟芎芍消肿汤	糠酸莫米松鼻喷剂	1个月	①②	未提及	无	无	无
王明晶2022	85	85	推拿+运脾化痰通窍方	孟鲁司特钠+中药安慰剂	3个月	①②③	6个月	脾虚痰阻证	无	无
宋瑶2022	75	75	推拿+清肺化痰通窍方	孟鲁司特钠+中药安慰剂	3个月	①②③	未提及	肺热壅鼻证	无	无
冼丽燕2023	40	40	推拿+艾灸百会穴+糠酸莫米松鼻喷雾剂	糠酸莫米松鼻喷剂	1个月	①②④	未提及	无	无	无
李文光2023	35	35	推拿+温肺止流丹合二陈汤	糠酸莫米松鼻喷剂	6周	①②	未提及	无	无	无
刘英2024	28	28	推拿+自拟化痰散结方	糠酸莫米松鼻喷剂	1个月	①②③	未提及	痰瘀互结证	2	2
赖艳平2024	39	39	推拿+玉屏风散加减	糠酸莫米松鼻喷剂	4周	①②	未提及	气虚痰滞证	无	无
陈丽钦2024	36	36	推拿+中药熏鼻+孟鲁司特钠+糠酸莫米松鼻喷雾剂	中药熏鼻+孟鲁司特钠+糠酸莫米松鼻喷剂	3周	①②	未提及	无	无	无
陈传强2024	40	40	推拿+自拟消腺方	自拟消腺方	1个月	①②④	未提及	痰凝血瘀证	无	无
注：T为推拿组；C为对照组；结局指标，①临床总有效率比；②中医证候评分；③腺样体肥大A/N比值；④生活质量评分。

下载: 导出CSV

参考文献(21)

[1]	韩子超, 安慧欣, 丁珍. 化痰清腺汤治疗儿童腺样体肥大30例疗效观察[J]. 江西中医药, 2025, 56(1): 40-42. Han Z C, AN H X, Ding Z. Observation of the therapeutic effect of Huatan Qingxian Decoction on 30 cases of pediatric adenoid hypertrophy[J]. Jiangxi Journal of Traditional Chinese Medicine, 2025, 56(1): 40-42.
[2]	林春琴, 林钱森, 王建新. 腺样体肥大的睡眠呼吸障碍儿童平均血小板体积和血小板分布宽度变化的临床意义[J]. 世界睡眠医学杂志, 2023, 10(5): 1063-1065. Lin C Q, Lin Q S, Wang J X. Clinical significance of mean platelet volume and platelet distribution width changes for adenoid hypertrophy children with sleep apnea[J]. World Journal of Sleep Medicine, 2023, 10(5): 1063-1065.
[3]	朱大建, 周光耀. 习惯性打鼾儿童的注意缺陷多动障碍研究进展[J]. 华西医学, 2024, 39(6): 985-988. Zhu D J, Zhou G Y. Research progress on attention deficit hyperactivity disorder in children with habitual snoring[J]. West China Medical Journal, 2024, 39(6): 985-988.
[4]	柳平, 胡思源, 蔡秋晗, 等. 中药治疗儿童腺样体肥大临床试验设计与评价概要[J]. 中国新药杂志, 2025, 34(3): 292-296. Liu P, Hu S Y, Cai Q H, et al. Clinical trial design and evaluation of traditional Chinese medicine in the treatment of adenoid hypertrophy in children[J]. Chinese Journal of New Drugs, 2025, 34(3): 292-296.
[5]	宫玲玲, 王伟, 蒋成义, 等. 小儿鼾症手术联合下鼻甲后端消融术对鼻腔通气功能的影响[J]. 中华全科医学, 2023, 21(1): 54-56. doi: 10.16766/j.cnki.issn.1674-4152.002810 Gong L L, Wang W, Jiang C Y, et al. Influence of paediatric snoring combined with posterior inferior distribution of the ventilation function on nasal ventilation[J]. Chinese Journal of General Practice, 2023, 21(1): 54-56. doi: 10.16766/j.cnki.issn.1674-4152.002810
[6]	王赛娜, 盛锋, 徐枫, 等. 推拿手法治疗儿童腺样体肥大的临床观察[J]. 中华中医药杂志, 2018, 33(3): 1155-1157. Wang S N, Sheng F, Xu F, et al. Clinical observation of Tuina in the treatment of adenoidal hypertrophy in children[J]. China Journal of Traditional Chinese Medicine and pharmacy, 2018, 33(3): 1155-1157.
[7]	姜之炎, 刘俊俊, 石李, 等. 运脾化痰通窍方联合鼻部按摩治疗儿童腺样体肥大的临床疗效及免疫调节作用[J]. 南京中医药大学学报, 2018, 34(1): 42-46. Jiang Z Y, Liu J J, Shi L, et al. Clinical effect and immune regulation of Yunpi Huatan Tongqiao Decoction combined with nasal massage for child adenoid hypertrophy[J]. Journal of Nanjing University of Traditional Chinese Medicine, 2018, 34(1): 42-46.
[8]	刘鲲鹏, 崔佳文, 顾非, 等. 推拿手法治疗小儿腺样体肥大的临床疗效观察[J]. 针灸推拿医学(英文版), 2021, 19(6): 425-431. Liu K P, Cui J W, Gu F, et al. Therapeutic efficacy observation of Tuina manipulation for pediatric adenoid hypertrophy[J]. Journal of Acupuncture and Tuina Science, 2021, 19(6): 425-431.
[9]	刘俊俊, 刘南萍, 王少明. 中药联用外治法治疗儿童腺样体肥大临床疗效[J]. 中医药临床杂志, 2021, 33(2): 377-382. Liu J J, Liu N P, Wang S M. Clinical efficacy of traditional chinese medicine in treating child adenoid hypertrophy[J]. Clinical Journal of Traditional Chinese Medicine, 2021, 33(2): 377-382.
[10]	邵梦洁. 自拟芎芍消肿汤配合推拿治疗小儿腺样体肥大22例[J]. 光明中医, 2021, 36(4): 578-580. Shao M J. Treatment of 22 cases of pediatric adenoid hypertrophy with Self-Formulated Chrysanthemum and Peony Decoction combined with Tuina Manipulation[J]. Guangming Journal of Chinese Medicine, 2021, 36(4): 578-580.
[11]	王明晶, 刘秀秀, 毛黎明, 等. 运脾化痰通窍方联合中医外治法治疗儿童腺样体肥大脾虚痰阻证的临床观察[J]. 中国中医基础医学杂志, 2022, 28(3): 428-431. Wang M J, Liu X X, Mao L M, et al. Clinical observation of Yunpi Huatan Tongqiao Formula combined with external treatment of Chinese medicine in treatment of spleen deficieney and phlegm obstruction syndrome of adenoid hypertrophy in children[J]. Journal of Basic Chinese Medicine, 2022, 28(3): 428-431.
[12]	宋瑶, 刘秀秀, 毛黎明, 等. 清肺化痰通窍方联合中医外治法治疗儿童腺样体肥大肺热壅鼻证多中心随机对照研究[J]. 中国中西医结合杂志, 2022, 42(3): 322-326. Song Y, Liu X X, Mao L M, et al. Efficacy of Qingfei Huatan Tongqiao Formula combined with external therapy in treating pediatric adenoid hypertrophy with fei-heat stagnated in nose: a multicenter randomized controlled trial[J]. Chinese Journal of Integrated Traditional and Western Medicine, 2022, 42(3): 322-326.
[13]	冼丽燕, 郑衍庆, 温伟红, 等. 艾灸百会结合穴位按摩护理对儿童腺样体肥大的效果研究[J]. 妇幼护理, 2023, 3(18): 4385-4387. Xian L Y, Zheng Y Q, Wen W H, et al. Study on the effect of moxibustion Baihui combined with acupoint massage nursing on children's adenoid hypertrophy[J]. Journal of Maternal and Child Health Care, 2023, 3(18): 4385-4387.
[14]	李文光, 沈志勇, 吴新风, 等. 温肺止流丹合二陈汤加减配合穴位按摩治疗小儿腺样体肥大临床观察[J]. 中文科技期刊数据库(文摘版)医药卫生, 2023(11): 90-94. Li W G, Shen Z Y, Wu X F, et al. Clinical observation of adenoid hypertrophy in children with lung pressure and acupoint massage[J]. Chinese Science and Technology Periodicals Database (Abstract Edition), Medical and Health, 2023(11): 90-94.
[15]	刘英, 朱玲, 汪娱, 等. 推拿联合中药治疗儿童腺样体肥大临床疗效观察[J]. 辽宁中医药大学学报, 2024, 26(3): 4-8. Liu Y, Zhu L, Wang Y, et al. Clinical effect observation of massage combined with traditional Chinese medicine on adenoid hypertrophy in children[J]. Journal of Liaoning University of Traditional Chinese Medicine, 2024, 26(3): 4-8.
[16]	赖艳平, 王彦军, 赵江波. 小儿推拿结合玉屏风散加减颗粒治疗腺样体肥大(气虚痰滞证)的临床观察[J]. 世界最新医学信息文摘(连续型电子期刊), 2024, 24(14): 122-125. Lai Y P, Wang Y J, Zhao J B. Clinical observation of children's massage combined with Yupingfeng Powder to treat adenoid hypertrophy (syndrome of qi deficiency and phlegm stagnation)[J]. World Latest Medicine Information(Continuous Electronic Journal), 2024, 24(14): 122-125.
[17]	陈丽钦. 小儿推拿联合中药熏鼻方对腺样体肥大患儿疗效及睡眠质量的影响[J]. 世界睡眠医学杂志, 2024, 11(5): 1030-1032. Chen L Q. Effect of pediatric massage combined with traditional Chinese medicine Fumigating Nasal Formula on the efficacy and sleep quality of children with adenoid hypertrophy[J]. World Journal of Sleep Medicine, 2024, 11(5): 1030-1032.
[18]	陈传强, 吴小华, 阮美江. 自拟消腺方配合外治法治疗小儿腺样体肥大痰凝血瘀证的临床观察[J]. 中国医药指南, 2024, 22(3): 102-105. Chen C Q, Wu X H, Ruan M J. Clinical observation of Self-Formulated Gland-Dissipating Formula combined with external treatment in the treatment of pediatric adenoid hypertrophy with phlegm stagnation and blood stasis syndrome[J]. Guide of China Medicine, 2024, 22(3): 102-105.
[19]	刘亚男, 李静. 中医外治法治疗小儿腺样体肥大临床研究进展[J]. 河北中医, 2022, 44(9): 1567-1572. Liu Y N, Li J. Clinical research progress of traditional Chinese medicine external therapy for adenoid hypertrophy in children[J]. Hebei Journal of Traditional Chinese Medicine, 2022, 44(9): 1567-1572.
[20]	李怡霏, 杨志华, 石玉蛟, 等. 基于"痰瘀热"辨治小儿腺样体肥大[J]. 亚太传统医药, 2023, 19(10): 113-117. Li Y F, Yang Z H, Shi Y J, et al. Treatment of adenoid hypertrophy in children based on syndrome differentiation of phlegm and blood stasis heat[J]. Asia-Pacific Traditional Medicine, 2023, 19(10): 113-117.
[21]	奉美华, 徐辉甫. 从"标本"论治小儿腺样体肥大[J]. 天津中医药大学学报, 2023, 42(1): 57-59. Feng M H, Xu H F. The treatment of children adenoid hypertrophy based on "manifestation and root cause"[J]. Journal of Tianjin University of Traditional Chinese Medicine, 2023, 42(1): 57-59.