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目的:系统评价头痛宁联合氟桂利嗪对比氟桂利嗪治疗偏头痛的疗效与安全性,为临床提供循证参考。方法:计算机检索PubMed、Cochrane 图书馆、Embase、中国期刊全文数据库、中文科技期刊数据库、万方数据库和中国生物医学文献数据库,收集头痛宁联合氟桂利嗪(试验组)对比氟桂利嗪(对照组)治疗偏头痛的疗效[总有效率、视觉模拟评分法(VAS)评分、血钾及血镁浓度、降钙素基因相关肽(CGRP)水平等]及安全性(不良反应发生率)的随机对照试验(RCT),对符合纳入标准的临床研究进行资料提取,并采用Cochrane 5.1.0 偏倚风险评估工具和Jadad量表进行质量评价后,采用Stata 14.0软件进行Meta分析,TSA 0.9软件进行试验序贯分析。结果:共纳入16项RCT,合计1 726例患者。Meta分析结果显示,试验组患者总有效率[RR=1.21,95%CI(1.16,1.26),P<0.05]、VAS评分降低程度[WMD=-1.04,95%CI(-1.42,-0.66),P<0.001]、血钾降低程度[WMD=-2.05,95%CI(-0.32,-0.18),P<0.001]、血镁提高程度[WMD=0.09,95%CI(0.04,0.14),P<0.001] 、CGRP水平降低程度[WMD= -2.22,95%CI(-3.25,-1.18),P<0.001]等方面均优于对照组,差异均有统计学意义。试验组不良反应发生率为2.27%,对照组为2.89%,两者比较差异无统计学意义(P>0.05);试验序贯分析提示头痛宁联合氟桂利嗪治疗偏头痛总有效率证据确切。结论:头痛宁联合氟桂利嗪对比氟桂利嗪治疗偏头痛的疗效更好,未增加不良反应事件的发生。
OBJECTIVE: To systematically evaluate therapeutic efficacy and safety of Toutongning combined with flunarizine vs. flunarizine in the treatment of migraine, and to provide evidence-based reference in clinic. METHODS: Retrieved from PubMed, Cochrane library, Embase, Chinese Journal Full-text Database, Chinese Sci-tech Periodicals Database, Wanfang database and CBM, randomized controlled trials (RCTs) about therapeutic efficacy (total response rate, VAS score, blood potassium and blood magnesium concentration, CGRP level) and safety (the incidence of ADR) of Toutongning combined with flunarizine (trial group) vs. flunarizine in the treatment of migraine (control group) were collected. Meta-analysis of included trials meet inclusion criteria was conducted by using Stata 14.0 software, and trial sequential analysis (TSA) was conducted by using TSA 0.9 software after data extraction and quality evaluation with Cochrane 5.1.0 bias risk evaluation tool and Jadad scale. RESULTS: Totally 16 RCTs were included, involving 1 726 patients. Results of Meta-analysis showed that total response rate [RR=1.21,95%CI(1.16,1.26),P<0.05], the decrease of VAS score [WMD=-1.04,95%CI (-1.42,-0.66),P<0.001], the decrease of blood potassium [WMD=-2.05,95%CI (-0.32,-0.18),P<0.001], the increase of blood magnesium [WMD=0.09,95%CI (0.04,0.14),P<0.001] and the decrease of CGRP [WMD=-2.22,95%CI (-3.25,-1.18),P<0.001] in trial group were better than control group, with statistical significance. The incidence of ADR in trial group was 2.27% in trial group and 2.89% in control group, without statistical significance (P>0.05). TSA showed that there were extract evidences for total response rate of Toutongning combined with flunarizine in the treatment migraine. CONCLUSIONS: Therapeutic efficacy of Toutongning combined with flunarizine is better than flunarizine in the treatment of migraine, and the ADR is not increased.
头痛宁氟桂利嗪偏头痛Meta分析试验序贯分析
ToutongningFlunarizineMigraineMeta-analysisTrial sequential analysis
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