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[近五年中医干预紧张型头痛随机对照试验的结局指标]

[Outcome indicators in randomized controlled trials on traditional Chinese medicine intervention for tension-type headache in recent five years].

作者信息

Gong Xiao, Wei Jing-Jing, Fu Guo-Jing, Fan Xue-Ming, Piao Jing-Ze, Chen Wen-Jie, Yan Yu, Zhang Yun-Ling, Guo Chun-Li, Liao Xing

机构信息

Xiyuan Hospital, China Academy of Chinese Medical Sciences Beijing 100091, China.

Xiyuan Hospital, China Academy of Chinese Medical Sciences Beijing 100091, China Graduate School, Beijing University of Chinese Medicine Beijing 100029, China.

出版信息

Zhongguo Zhong Yao Za Zhi. 2021 Sep;46(18):4591-4600. doi: 10.19540/j.cnki.cjcmm.20210722.502.

Abstract

To evaluate the application of outcome indicators in randomized controlled trials(RCTs) concerning the treatment of tension-type headache(TTH) with traditional Chinese medicine(TCM) in recent five years, so as to provide a basis for the study of core outcome set(COS) for TCM intervention in TTH. The RCTs on TCM treatment of TTH in recent five years were systematically retrieved from CNKI, Wanfang, VIP, CBM, EMbase, PubMed, Cochrane Library, Web of Science, ClinicalTrials.gov and China Clinical Trial Registry. After literature screening, data extraction and evaluation of the risk of bias, the outcome indicators in the included RCTs were subjected to qualitative analysis. The preliminary search yielded 19 042 articles, and 10 983 were left after the elimination of duplication. Finally, 52 RCTs(48 in Chinese and 4 in English) were included for qualitative analysis. The outcome indicators of RCTs included in this study were classified into seven domains: TCM syndrome, symptom and sign, physical and chemical detection, quality of life, long-term prognosis, economic evaluation, and safety event. The findings demonstrated that headache characteristic index in the symptom and sign domain was the index with the highest reporting frequency and reporting rate. Seventeen RCTs used TCM syndrome score as the outcome indicator. Further analysis revealed that there existed such problems in research design as non-distinction between primary and secondary outcome indicators, great difference in the adopted measurement tools for outcome indicators, and the neglect of measurement time of outcome indicators. Moreover, the syndrome indicators reflecting TCM advantages, objective evaluation indicators, safety and health-economic indicators were lacking. These limitations have affected the quality and reliability of RCTs on TTH treatment with TCM. It is suggested that the efficacy and characteristics of TCM should be combined into current clinical research, and the COS in RCTs regarding TCM treatment of TTH should be established according to internationally recognized standard procedures.

摘要

评估近五年中医药治疗紧张型头痛(TTH)的随机对照试验(RCT)中结局指标的应用情况,为TTH中医干预核心结局集(COS)的研究提供依据。通过检索中国知网、万方、维普、中国生物医学文献数据库、EMbase、PubMed、Cochrane图书馆、Web of Science、ClinicalTrials.gov和中国临床试验注册中心,系统收集近五年中医药治疗TTH的RCT。经文献筛选、数据提取及偏倚风险评估后,对纳入RCT的结局指标进行定性分析。初步检索得到19042篇文献,去重后剩余10983篇。最终纳入52项RCT(中文48项,英文4项)进行定性分析。本研究纳入RCT的结局指标分为七个领域:中医证候、症状体征、理化检测、生活质量、远期预后、经济学评价和安全事件。结果表明,症状体征领域的头痛特征指数是报告频率和报告率最高的指标。17项RCT将中医证候评分作为结局指标。进一步分析发现,研究设计存在主要结局指标与次要结局指标区分不清、结局指标所采用的测量工具差异较大、忽视结局指标测量时间等问题。此外,缺乏体现中医优势的证候指标、客观评价指标、安全性及卫生经济学指标。这些局限性影响了中医药治疗TTH的RCT的质量和可靠性。建议将中医药的疗效和特色融入当前临床研究中,并按照国际公认的标准程序制定中医药治疗TTH的RCT中的COS。

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