基于网状Meta和GRADE系统构建针灸治疗带状疱疹临床证据分级库及推荐方案的研究

In recent years, the incidence of herpes zoster is in a growing trend. Its legacy neuralgia seriously impacts patients' quality of life and causes severe disease burden. In recent years, the incidence of herpes zoster (HZ) is in a growing trend. Its legacy neuralgia seriously impacts patients' quality of life and causes severe disease burden. However, western medicine for HZ has certain limitations. The methods of acupuncture for herpes zoster are diverse and its efficacy is exact. Effective acupuncture treatment should be based on the current best available research evidence. Although the evidence of acupuncture for HZ is increasing year by year, it still lacks of scientific classification and recommendation. Thus, the effective treatment cannot get timely transformation and application but long-term use of ineffective treatment. In this study, Network-meta Analysis will be used to compare the efficacy of different acupuncture methods for HZ. GRADE（Grading of Recommendations Assessment，Development，and Evaluation）will be used to evaluate the quality of the clinical evidence, rate the recommended strength and build a database of clinical evidence. AGREE will be used to evaluate the evidence quality of different guidelines of acupuncture for HZ and summary effective treatment measures. Above evidence rating and recommendation combined with the result of expert consultation and the Delphi method comprehensively evaluate the advantage and disadvantage of different acupuncture for HZ. Research aims to build the evidence classification database of acupuncture for HZ, Form the current best recommendation treatment programs and improve the level of clinical practice. Also, the research method in our study can provide reference for similar studies carried out in the future.

近年来，带状疱疹发病率呈增长趋势，其遗留神经痛严重影响患者生活质量，疾病负担严重，西医治疗具有一定局限性。针灸治疗带状疱疹方法多样，疗效确切，具有一定优势。有效的针灸治疗应基于当前最佳研究证据，虽然针灸治疗带状疱疹研究逐年增多，但研究质量良莠不齐，缺乏对研究证据科学分级和方案推荐，以致有效治疗无法得到及时转化和应用，无效治疗却长久使用。本研究以Network-meta法比较不同针灸治疗带状疱疹疗效的优劣并排序；以证据评价及推荐系统(GRADE)评价研究质量，并进行推荐强度评级，构建临床证据数据库；采用指南评价工具AGREE评价不同治疗指南方法学质量并归纳有效治疗措施；结合以上证据评级及推荐，并采用专家咨询法、德尔菲法综合评价不同针灸方法的治疗优劣。研究旨在构建针灸治疗带状疱疹的临床证据分级数据库，形成目前最优的推荐方案，提高临床实践水平；研究方法可为日后同类研究的开展提供示范借鉴作用。

研究背景.近年来，带状疱疹发病率呈增长趋势，其遗留神经痛严重影响患者生活质量，疾病负担严.重，西医治疗具有一定局限性。针灸治疗带状疱疹方法多样，疗效确切，具有一定优势。有效的针灸治疗应基于当前最佳研究证据，虽然针灸治疗带状疱疹研究逐年增多，但研究质量良莠不齐，缺乏对研究证据科学分级和方案推荐，以致有效治疗无法得到及时转化和应用，无效治疗却长久使用。.主要研究内容.本研究以Network-meta法比较不同针灸治疗带状疱疹疗效的优劣并排序；以证据评价及推荐系统(GRADE)评价研究质量，并进行推荐强度评级，构建临床证据数据库；采用指南评价工具AGREE评价不同治疗指南方法学质量并归纳有效治疗措施；结合以上证据评级及推荐，评价不同针灸方法的治疗优劣。.研究结果.建立针灸治疗带状疱疹及带状疱疹后遗神经痛的随机对照研究文献数据库及提取信息。分别将电针、刺络拔罐、火针、温热疗法等针灸干预措施为主，对照组为常规抗病毒、营养神经的带状疱疹治疗，进行疗效的系统评价及相关结局的GRADE评级。以针灸临床随机对照研究的的显愈率为网状Meta分析的疗效指标，运用STATA绘制网状图通过对不同干预措施的显愈率进行定量排序。将录入的数据导入WinBUGS 软件，选择随机效应模型。针灸治疗带状疱疹的干预措施从优排序结果：火针+拔罐＞刺络+铺棉灸＞火针+温和灸＞电针+围刺＞电针+围刺+刺络+拔罐＞电针+围刺+火针＞电针+围刺+铺棉灸＞西药。火针+拔罐是目前治疗带状疱疹的最佳针灸干预措施。对比其他火针疗法，火针联合拔罐组疼痛持续时间最短［WMD=-2. 85，95%CI（-3. 84，-1. 86）］，推荐级别为弱推荐。完成带状疱疹临床实践指南的现状认识与可靠的方法学评价，对现有实践指南的不足进行了总结及分析，构建针灸治疗带状疱疹的循证推荐方案。.研究意义.旨在构建针灸治疗带状疱疹的临床证据分级数据库，形成目前最优的推荐方案，提高临床实践水平；研究方法可为日后同类研究的开展提供示范借鉴作用。