發(fā)布時間：2018-01-22 03:52

  本文關鍵詞： 初治肺結核 薈萃分析 中西醫(yī)結合　出處：《浙江中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的評價中西醫(yī)結合治療初治肺結核的療效方法以"初治肺結核"、"中醫(yī)"、"中西醫(yī)"、"湯"、"方"為檢索詞,計算機檢索相關期刊論文(CNKI)、萬方數據知識平臺、中文科技期刊全文數據庫-維普資訊、PubMed中有關中西醫(yī)結合治療初治肺結核的文獻,依據Cochrane評價手冊評價文獻質量,并提交數據進行薈萃分析,利用RevMan5.3統計軟件進行薈萃分析,分類變量計算比值比(OR)以及95%可信區(qū)間(CI)。結果共檢出相關文獻974篇,含論文題目、作者姓名、出處以及摘要,查重排除文獻剩余文獻325篇,閱讀題目及摘要排除不相關文獻,剩余文獻40篇,進一步閱讀全文后,剔除數據不完整、觀察指標不同及非隨機對照(RCT)的文獻,最后有16篇文獻3100例患者納入分析,其中中西醫(yī)結合組1589例,單純西醫(yī)治療組1521例,兩組基線數據一致。薈萃分析結果顯示:(一)治療2月末痰菌轉陰:有10篇文獻入選,對照組976例治療組930例,與單純西醫(yī)治療對照組相比,OR=3.41,95%CI2.71～4.38,OR1且95%CI不包含1,總效應檢測Z=10.09,P0.01,差異有統計學意義,提示治療2月中西醫(yī)結合治療組2月末痰菌轉陰率高于單純西醫(yī)治療組。(二)治療2月末空洞閉合:有6篇文獻入選:對照組210例治療組232例,與單純西醫(yī)治療對照組相比OR=3.87,95%CI 1.91～7.83,OR1且95%CI不包含1,總效應檢測Z=5.62,P0.01,差異有統計學意義,提示治療2月中西醫(yī)結合治療空洞閉合率高于單純西醫(yī)治療組。(三)治療2月末病灶吸收:有7篇文獻入選:對照組526例治療組560例,與單純西醫(yī)治療對照組相比OR=2.52,95%CI1.64～3.87,OR1且95%CI不包含1,總效應檢測Z=4.23,P0.01,差異有統計學意義,提示治療2月中西醫(yī)結合組病灶吸收率高于單純西醫(yī)治療組。(四)治療6月末痰菌轉陰:有10篇文獻入選:對照組847例治療組872例,與單純西醫(yī)治療對照組相比OR=4.3,95%CI 2.78～6.65,OR1且95%CI不包含1,總效應檢測Z=6.54,P0.01,差異有統計學意義,提示治療6月中西醫(yī)結合治療組痰菌轉陰率高于單純西醫(yī)治療組。(五)治療6月末空洞閉合:有8篇文獻入選:對照組295例治療組322例,與單純西醫(yī)治療對照組相比OR=2.24,95%CI 1.46～3.44,OR1且95%CI不包含1,總效應檢測Z=3.68,P0.01,差異有統計學意義,提示治療6月中西醫(yī)結合治療組空洞閉合率高于單純西醫(yī)治療組。(六)治療6月末X線病灶吸收:有10篇文獻入選:對照組641例治療組696例,與單純西醫(yī)治療相比OR=3.49,95%CI 2.47～4.94,Z=7.08,P0.01,差異有統計學意義,提示治療6月中西醫(yī)結合治療組X線病灶吸收率高于單純西醫(yī)治療組。(七)臨床療效:有7篇文獻入選:對照組567例治療組604例,與單純西醫(yī)治療相比OR=3.32,95%CI 2.15～5.14,OR1且95%CI不包含1,合并效應量的檢驗Z=5.41,P0.01,差異有統計學意義,提示中西醫(yī)結合治療組臨床療效高于單純西醫(yī)治療組。結論中西醫(yī)結合治療初治肺結核,治療2月末及6月末,在痰菌轉陰、空洞閉合及X線病灶吸收均高于單純西醫(yī)治療,臨床療效中西醫(yī)結合治療優(yōu)于單純西醫(yī)治療。
[Abstract]:Objective to evaluate the curative effect of combination of traditional Chinese and Western medicine treatment of pulmonary tuberculosis with pulmonary tuberculosis "," Chinese medicine "and" western medicine "," soup "," party "as the key words, the computer retrieval Chinese Journal Full-text Database (CNKI), Wanfang Data knowledge platform, Chinese PSTP - VIP information, treatment of primary pulmonary tuberculosis in literature about the combination of traditional Chinese and Western medicine in PubMed, according to the Cochrane evaluation manual evaluation, and submit data for meta-analysis, meta-analysis was performed using RevMan5.3 statistical software, classification variables to calculate the odds ratio (OR) and 95% confidence interval (CI). Results there were 974 literatures, including the title, author's name, and the source, check out the remaining 325 articles, reading the title and abstract excluding the related literature, the remaining 40 references for further reading the whole text, excluding incomplete data, different observation index and non random Machine control (RCT) literature, finally 16 articles were included in the analysis of 3100 cases of patients, 1589 cases of combination of traditional Chinese and Western medicine group, western medicine treatment group 1521 cases, two groups of baseline data. The meta-analysis showed that: (a) treatment at the end of 2 negative sputum: 10 literatures were selected, the control group 976 patients in the treatment group 930 cases, control group compared with the pure western medicine treatment, OR=3.41,95%CI2.71 ~ 4.38, OR1 and 95%CI do not contain 1, the total effect of detection of Z=10.09, P0.01, the difference was statistically significant, indicating that the treatment of combining traditional Chinese and Western medicine treatment group in February 2 at the end of the sputum negative conversion rate is higher than the western medicine treatment group (two) of 2 at the end of treatment. Cavity closure: 6 articles were included: 210 cases in the control group and 232 cases in the treatment group, the control group from 1.91 to 7.83 OR=3.87,95%CI compared with the pure western medicine treatment, OR1 and 95%CI do not contain 1, the total effect of detection of Z=5.62, P0.01, the difference was statistically significant, indicating that the treatment of February combined treatment of TCM and Western Medicine The cavity closure rate is higher than the pure western medicine treatment group (three). 2 at the end of treatment: the lesions absorption of 7 articles were included: 526 cases in the control group and 560 cases in the treatment group, the control group to 3.87 OR=2.52,95%CI1.64 compared with the pure western medicine treatment, OR1 and 95%CI do not contain 1, the total effect of detection of Z=4.23, P0.01, the difference was statistically significant, suggesting that the combination of TCM and Western medicine treatment in February the focus absorption rate is higher than the pure western medicine treatment group (four). 6 at the end of treatment negative sputum: 10 literatures were included: 847 cases in the control group and 872 cases in the treatment group, the control group from 2.78 to 6.65 OR=4.3,95%CI compared with the pure western medicine treatment, OR1 and 95%CI do not contain 1, the total effect of detection Z=6.54. P0.01, the difference was statistically significant, indicating that the treatment in June, combining traditional Chinese and Western medicine treatment group the sputum negative conversion rate higher than the treatment group western medicine. (five) 6 at the end of treatment: void closure 8 articles included: 295 cases of control group, 322 cases in the treatment group, compared with the pure western medicine treatment Compared with OR=2.24,95%CI 1.46 ~ 3.44, OR1 and 95%CI do not contain 1, the total effect of detection of Z=3.68, P0.01, the difference was statistically significant, indicating that the treatment of combining traditional Chinese and Western medicine treatment group June cavity closure rate higher than the treatment group western medicine. (six) absorption treatment at the end of 6 there are 10 X-ray lesions: Literature: selected 641 cases in the control group the treatment group of 696 cases, compared with the pure western medicine treatment of 2.47 ~ 4.94 OR=3.49,95%CI, Z=7.08, P0.01, the difference was statistically significant, indicating that the treatment of combining traditional Chinese and Western medicine treatment group June X-ray focus absorption rate is higher than the pure western medicine treatment group. (seven) clinical curative effect: 7 articles were included: 567 cases in the control group and the treatment group of 604 cases. The pure western medicine treatment compared to OR=3.32,95%CI from 2.15 to 5.14, OR1 and 95%CI do not contain 1, the combined effect of the amount of the test of Z=5.41, P0.01, the difference was statistically significant, suggesting that combined with the clinical effect of treatment group was higher than that of Western medicine treatment group and Western medicine. Conclusion the traditional Chinese medicine and Western Medicine Combined with the treatment of the initial treatment of tuberculosis, treatment at the end of 2 and the end of 6, sputum smear negative, cavity closure and X-ray lesion absorption were higher than that of Western medicine alone. The clinical efficacy of integrated traditional Chinese and Western medicine is better than that of Western medicine alone.

【學位授予單位】：浙江中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R521

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