【作者】 伍敏新；

【导师】 黄泳；

【作者基本信息】 南方医科大学 ， 中西医结合临床， 2011， 博士

【摘要】 目的：对针灸治疗老年痴呆的随机对照临床试验文献进行质量评价,分析针灸治疗老年痴呆临床研究的研究现状以及研究方法和文献撰写存在的问题,为提高该类临床研究水平和文献质量提供参考；运用循证医学的原理和方法,对近年来国内发表的有关针灸治疗老年性痴呆的文献进行了Meta-分析,以期为临床针灸治疗痴呆提供可靠的依据；对针灸治疗老年痴呆的中医证型,治法和用药规律进行总结分析,为针灸治疗老年痴呆的辩证论治研究提供参考。方法：采用检索词交叉检索,并辅以文献追溯、文献链接等方法补充,对2001—2010年在CNKI、维普等上公开发表的针灸治疗老年痴呆的文献进行电子检索。根据循证医学和临床流行病学的评价方法,并结合中医药研究的特色,采用Jadad评分和设计制作文献质量评价表,对文献进行质量评价。论文分三部分进行：计量学分析；Meta分析及用穴规律分析。Meta分析应用RevMan5.02软件进行分析；课题学分析及用穴规律分析应用EXCEL进行分析。结果：1计量学分析结果示：(1)基金来源文献：逐一查阅检出数据,剔除新闻报道性文献、重复性文献及摘要文献等,获得针灸治疗痴呆症文献共计235篇。其中含有基金支持的文章为47篇；(2)文献来源地分布情况：235篇论文的作者分布在全国各个省市,其中发文超过20篇的为广东和天津,共发文75篇,占发文总数的31.9%,表明上述省市在针灸治疗痴呆症方面处于全国领先地位；(3)发表期刊分布情况：在以“痴呆症”及“针灸”为第一主题的文献中,从发表期刊来看,专题类期刊最多,这里只列举了八种文献比较多的期刊,八种期刊所发表的文献中,占总文献的40.9%。其中,以《中国针灸》杂志上发表文章最多；(4)文献类型：临床研究的文献最多,共96篇,占总数的41.1%,其次为综述类文献,再者为实验研究文献；(5)所属机构：作者所属机构可以总结为高校、医院、研究所这三个主要的机构,发文总数最多的机构为医院,占总文献数的48.1%；其次为高校,为26.4%。其中,除了小部分为研究所等科研机构外,大部分是高校及医院。可见,医院和高校是研究痴呆症的主要研究机构；(6)治疗手段：总结了临床研究的96篇文献中的治法研究,其中属单纯针刺出现得最多,达到38次,其次为针刺+中药和针刺+西药各出现了17次,总共占了所有临床研究文献的74%。所以,临床研究中的治法研究主要以针刺为主；(7)对照组用药情况：文献中使用中药的几率较大,占了12.9%；其次为尼莫地平和脑复康,各占了10.1；都可喜也占了7.9%。2 Meta分析：将19个研究合并进行异质性检验(P=0.55 12=0%)；表明所纳入研究具有临床及统计学上的同质性,[OR=3.31, (95% CI=2.51,4.36)],整体效果检验Z=8.51(P<0.00001)。即针灸与药物比较在治疗痴呆症总有效率方面有优势。3用穴规律分析：(1)经络分布情况：针灸治疗阿尔茨海默氏病的临床对照研究中,虽然使用的腧穴涉及大部分经络,但穴位集中在督脉上,其所属腧穴百会等作为主穴使用110次,占所有主穴的43.0%；所属腧穴印堂等作为配穴共使用20次,占所有配穴的9.2%。其次为手少阴心经,其所属腧穴神门作为主穴使用32次,占主穴的12.5%。足太阳膀胱经腧穴作为配穴的使用率最高,共使用腧穴23个,占本经44个腧穴的34.3%,其次为督脉,共使用腧穴5个,占本经28个腧穴的17.9%；(2)主穴选穴情况：主穴选用率由高到低排列依次为：百会(督脉)、神门(手少阴心经)、大椎(督脉)、风池(足少阳胆经)、四神聪(经外奇穴)、足三里(足阳明胃经)、三阴交(足太阴脾经)、内关(手厥阴心包经)、水沟(督脉)、神庭(督脉)；(3)腧穴所属部位统计：以头面部及腰背部穴位使用最多；(4)特定穴使用统计：五输穴及背俞穴应用最多,各占到所用穴位的18%。结论：综上所述,我们认识到,老年痴呆正日渐成为影响人类健康的一个重大的疾病。研究副作用少而疗效确切的治疗本病的治疗方法持续成为近年关注的热点。针灸治疗痴呆,历史源远流长,本次研究按照循证医学的原则和方法进行评价分析,现有证据表明,针灸疗法对于痴呆确实有效,施加的干预措施有利于疾病的改善。这吸引了不少医学工作者参与到其中的应用与研究中来。在他们各自的治疗过程中,有共识,也有有争议的地方。对痴呆病位,病因病机,病性的认识基本趋于有统一的认识；而在辩证分型,论证侧重方面则争议较多。这就使得针灸治疗痴呆的处方呈现集中分布趋势与多经多穴分散使用并存的局面。同时还存在临床RCT的设计和实施有失规范的现象。为此,临床医生应更加完善对针灸治疗痴呆的科研设计,以提高RCT质量,更好地指导临床治疗。同时,我们要在分析各人经验的基础上,博采众长,去伪存真,总结出治疗AD的最优处方,为患者造福。更多还原

【Abstract】 OBJECTIVES:To assess the methodologieal and report quality of the randomized controlled trials using acupuncture in the treatment of Sneile Dementia. Individual assesement for each RCT articles was carried out to evaluate the research quality level and to find the inherent problems.This quality review aims to raise the standard of Chinese Medieine treatment for Senile Dementia and to provide reference for clinical researehers. The methods of TCM treatment on Senile Dementia were summarized for further studies. Meta-analysis was conducted on recent years articles of the relevant acupuncture treatment of Sneile Dementia to provide a reliable basis for acupuncture treatment of clinical Sneile Dementia.METHODS:Research artieles published in recent 10 years were searched from CNKI and PubMed websitesAnd eligible studies were seleeted according to the inclusion criteria. Jadad scale and individualAnalysis were used to assess the quality of the researches based on the principles of Evidence-Based Medieine(EBM) and clinical epidemiology.The percentage is calculated for the analysis of the treatment measures of Chinesemedieine. Microsoft Office Exeel 2007 was used for data proeessing and statistical analysis. This article was divided into three parts:Metrological Analysis, Meta-analysis and Selecting Points Rules. The Cochrane Collaboration’s RevMan 5.0.2 software was used for meta analyses. Microsoft Office EXCEL was used for Metrological Analysis and Selecting Points Rules.RESULTS:1. Rerults of Bibliometric analysis:(1)source of funds:there were 47 literatures which supported by some kind of funds in the total of 235 literatures. (2) in the total of 235 literatures, there were 75 literatures comes from GuangDong province and TianJin city, it taked the accout of 31.9%, it indicated that these tow place stand forwords in studying AD around the country. (3)the literatures most be published in Chinese Acupuncture and Moxibustion. (4) there were 96 CT literatures, taked the accout of 41.1%, this kind of literatures was the most, then the summarization literatures next. (5) institutions:in the institutions of high school, hospital and research department, the hospitals dedicate the most literatures, then the high schools. (6) therapy methods:to summarize the total of 96 CT literatures, the therapy of acupuncture was used most, it accounted to 38 times, then the acupuncture+ TCM+medicine, this accounted to 17 times. The usage in the control group:TCM was used the most, taked the account to 12.9%. Then Nimodipine and Piracetam.2. Meta-analysis:A total of 19 trials were received heterogeneity test(P=0.55 I2=0%); it showed that these studies had the clinical and statistical homogeneity, [OR=3.31, (95% CI=2.51, 4.36)], and combined effect of the value of Z=8.51(P<0.00001), implying that there was sufficient evidence to prove a superior effect of acupuncture over medicine.3. the law of using acupoints:(1) meridians and collateralsthe most acupoints located in the DU meridian, such as baihui, yintang, ect. The acupoints on the heart channel of hand shaoyin were also most used, only next to the DU meridian, such as shen men. But the acupoints in the urinary bladder channel of foot taiyang were used most frequently. (2)the main acupoints:the used of main acupoints were stand next as follows:BaiHui,ShenMen, DaZhui,FengChi,SiShenCong, ZuSanLi, SanYinJiao, NeiGuan, ShuiGou, ShenTing; (3) acupoints most located on the face and the back; (4) specific acupoint, back-shupoints were used the most.Conclusion:According to the results, we can easily recognize that Senile Dementia is becoming a significant disease which can influence human health. Studies focusing on the treatment to which has less side effect and accurate therapeutic effect are hot recently. Treating Senile Dementia by acupuncture has a long history, and our research was analysed and criticized under the principles and methods of Evidence-Based Medicine. We can inferred from the existent evidences that acupuncture do have effect on curing Senile Dementia.更多还原