中医药治疗腰椎间盘突出症的临床试验注册现状分析

目的：基于中国临床试验注册中心（ChiCTR）和美国临床试验注册中心（ClinicalTrials.gov）数据库，分析总结中医药治疗腰椎间盘突出症临床试验注册现状，为今后相关临床试验注册和实施提供借鉴。方法：系统检索ChiCTR和ClinicalTrials.gov建库至2023年5月31日收录的中医药治疗腰椎间盘突出症注册临床试验，2名研究者独立进行试验筛选和数据提取，采用Microsoft Excel 2019录入数据，并进行整理统计。结果：最终纳入87项中医药治疗腰椎间盘突出症注册临床试验，包括78项干预性研究和9项观察性研究。国内注册地区涉及17个省级行政区，注册数量最多的是上海市和北京市，经费来源以地方财政为主。干预措施多为中医药疗法的联合，结局指标以疗效性指标为主，安全性指标较少。结论：目前中医药治疗腰椎间盘突出症临床试验注册数量呈上升趋势，但整体数量仍偏少。研究者应重视注册细节和研究方案方面的优化，进一步提升注册质量。     

2007-2020年中医药治疗心血管疾病临床试验注册情况述评

梳理中国临床试验注册中心和美国ClinicalTrials.gov注册平台中中医药治疗心血管疾病临床试验的注册现状,汇总高质量研究成果并分析存在的问题,为把握相关研究发展动态提供参考.共纳入分析489项已注册的中医药治疗心血管疾病的临床试验,包括干预性研究409项(83.64％)、观察性研究80项(16.36％);所研...     

中医药防治近视临床试验注册现状分析

目的探讨中国临床试验注册中心（ChiCTR）与美国临床试验数据库（ClinicalTrials.gov）中注册的中医药防治近视注册临床试验的研究特征。方法 利用R语言与Excel软件分析ChiCTR数据库与ClinicalTrials.gov数据库中,应用中医药防治近视的相关临床试验的基本信息与方案设计信息特征,检索时间为建库至2022年12月31日。结果共纳入34项临床试验,注册单位覆盖全球2个国家、11个地区。经费或物资来源以地方财政（12项,占比35.29%）最多;研究类型以干预性研究最多（32项,占比94.12%）;研究设计以随机平行对照试验最多（28项,占比82.35%）,其中,大部分随机平行对照试验注明了随机化方法（24项,占比85.82%）,小部分注明了盲法（11项,占比39.29%）;6项临床试验使用中医体质评分或中医证候评分量表;干预措施包括针刺治疗（8项,占比25.00%）、耳穴压丸（7项,占比21.88%）、中医综合疗法（5项,占比15.63%）等8类。结论 中医药防治近视临床试验注册数量偏少,研究热点为近视的针刺治疗。建议强化中医药独特优势,提高中医药服务能力,...     

中国临床试验注册中心注册中医药真实世界研究特征分析

目的：基于中国临床试验注册中心平台（ChiCTR）的注册信息,对中医药真实世界研究现状进行特征分析。方法：在ChiCTR中检索中医药真实世界研究,检索时间为自建库至2021年10月31日。筛选并提取研究目的、样本量、干预措施、评价指标等数据,采用描述性分析方法。结果：共纳入中医药真实世界研究208项,多为前瞻性研究,研究方法以观察性研究为主,样本量3 054 440例;近10年中医药真实世界研究注册数量呈上升趋势;多中心研究的有99项,其中研究中心数最高达89项中心;研究实施周期平均29个月,最长研究周期达20年4个月;研究申办单位地域分布以北京、广东、上海为主,申办单位以医院类最多;经费来源以科研和课题经费为主;干预措施主要为口服中成药类;研究对象以心脑血管疾病、呼吸系统疾病和肿瘤3类疾病为主。结论：中医药真实世界研究注册量呈上升趋势,该领域研究注册仍存在研究者对于真实世界研究的认识理解不足、对临床试验注册的重视度不够、注册地质量不高、注册地域分布不均衡等问题。     

世界卫生组织国际临床试验注册平台针灸治疗疼痛临床试验注册情况分析

目的 总结2017至2021年针灸治疗疼痛相关临床研究的注册情况,分析该领域研究现状和热点。方法 检索世界卫生组织国际临床试验注册平台（WHO ICTRP） 2017年1月1日至2021年6月30日期间注册的针灸治疗疼痛的相关试验。提取纳入研究的注册时间、试验完成情况、注册中心与申请国家等基本信息和试验设计、疾病类型、干预措施、结局指标等信息,并进行统计与分析。结果 最终纳入针灸治疗疼痛的相关试验519项。纳入试验中,已完成项目94项（18.11%）,其中上传试验结果的仅15项;涉及的临床试验注册中心有13个,注册数量前五位的为中国临床试验注册中心（ChiCTR,234项）、美国临床试验注册中心（ClinicalTrials. gov,158项）、伊朗临床试验注册中心（IRCT,32项）、韩国临床研究信息服务中心（CRIS,27项）、巴西临床试验注册中心（REBEC,17项）。研究申请数量前五位的国家依次为中国（310项）、美国（45项）、伊朗（35项）、韩国（34项）、巴西（21项）。研究设计方面,干预性研究共495项,其中433项（87.47%）为平行组研究,观察性研究21项,其中...     

基于美国ClinicalTrials.gov分析中医药临床试验注册特点

近10年,中医药临床试验在美ClinicalTrials.gov注册的试验数量不断增多。为了解中医药临床试验注册特点,本研究全面检索美国ClinicalTrials.gov注册库,采用EXCEL表对纳入分析的临床试验逐条录入。最终纳入348个中医药临床试验,结果显示中国是中医药临床试验注册的主要国家,其次是美国;中医药临床试验以干预性研究、院校和医院主办、评价药品的安全性或（和）有效性为主;中医药干预性研究中,中国大陆主办、公司主办、招募中试验及多中心研究试验比例增加,中国香港、台湾主办、研究完成试验、研究状态不清楚试验、Ⅲ期临床试验及研究发表试验比例下降;中医药临床试验研究发表比例较低,试验注册信息缺失类型多、比例高。     

中医药防治糖尿病周围神经病变临床试验注册现况分析及评价

[目的] 通过检索国内外糖尿病周围神经病变（DPN）中医药临床试验注册情况,归纳其特征及发展趋势,为今后开展中医药防治DPN临床试验设计提供参考。[方法] 应用计算机在国际临床试验注册平台（WHO ICTRP）检索DPN中医药临床试验;检索时限为建库至2022年8月31日。对检索DPN中医药临床试验进行查重并提取相关数据。提取相关临床试验信息,并归纳DPN中医药临床试验特征（注册时间、地域及机构、设计类型、样本量、干预措施、结局指标）。[结果] 纳入中医药防治DPN临床试验26项;临床试验注册地均为中国,均在国内开展相关临床试验;注册单位分布在全国10个省级行政区,20家临床注册机构。分布最多的3个地区分别为上海市（8项）、北京市（5项）、广东省（5项）;经费来源以省级基金资助最多为8项,其次为院级科研基金资助6项;研究类型以干预性研究为主,随机平行对照试验是在册DPN的主要研究设计类型,12项研究为预试验,构成比为46.15%;纳入临床试验总样本量为3 854例,13项临床试验受试者例数≤100例;5项试验以针灸为干预措施;试验注册设计了145个结局指标,23项试验设计了神经传导速度。[结论] 中医药防治DPN临床试验注册数量整体偏少,数量呈上升趋势,中医药防治DPN优势明显,但在临床试验设计和注册规范性方面有待加强。     

太极拳相关临床试验注册特征与报告质量评价研究

目的评价太极拳相关临床试验的注册特征和报告质量。方法检索中国临床试验注册中心(ChiCTR)和美国临床试验数据库(ClinicalTrials.gov), 搜集太极拳相关临床试验的基本信息、研究内容、干预措施等注册信息, 检索时限均从建库至2022年6月30日。采用WHO试验注册数据集(TRDS)评价临床试验的注册质量。结果共纳入381项太极拳相关临床试验, 其中预注册试验241项(63.25%), 补注册试验140项(36.75%)。太极拳相关临床试验注册数量整体呈递增趋势, 2020年最高(14.70%);注册地区中, 上海注册量最多(9.97%);研究机构中, 福建中医药大学注册项目最多(4.46%);医院和高校(55.12%)是研究经费主要来源;认知障碍(7.87%)是研究最多的病症。随机平行对照试验(74.54%)为主要研究设计方案, 样本量主要在20～200之间(80.31%), 受试者年龄主要在39岁以上(53.28%)。WHO TRDS条目平均报告完成度为86.90%。结论目前太极拳相关临床试验发展趋势较好, 但在注册地区与单位分布、经费分配、受试人群等方面存在不均衡现...     

我国中医疗法治疗失眠临床试验注册现状分析

目的：通过分析中国临床试验注册中心（ChiCTR）登记注册的中医疗法治疗失眠的临床试验,探究中医疗法治疗失眠的临床研究现状及发展趋势。方法：检索ChiCTR从建库至2022年5月1日登记注册的中医疗法治疗失眠的临床试验,采用Excel 2019软件建立数据库,采用SPSS 26.0统计软件进行数据分析,归纳、总结中医疗法治疗失眠的临床试验的现状及发展趋势。结果：本研究共纳入114项中医疗法治疗失眠的临床试验,注册地域涉及23个省（直辖市、自治区）,66个机构,注册临床试验数排名前3的地区分别是上海（27项,23.68%）、北京（22项,19.3%）、广东（14项,12.28%）。临床试验的经费来源主要以地区财政（40项,35%）和国家财政（21项,18%）支持为主。研究类型以干预性研究为主（110项,96.49%）,研究设计主要以随机平行对照试验（94项,82.46%）为主,但仅有42项（36.84%）研究指出实施盲法,仅16项（14.04%）研究对失眠的证型进行描述。干预措施以针刺（59项,51.75%）和中药（27项,23.68%）为主;24项明确指出中药治疗失眠的临床试验中,以医...     

中国糖尿病视网膜病变临床试验注册现状分析

目的 分析中国临床试验注册中心（ChiCTR）糖尿病视网膜病变（DR）相关临床研究的现状。方法 检索ChiCTR建库至2022年8月8日注册的DR临床试验，并对相关信息进行汇总分析。结果 最终纳入研究125项，包括干预性研究45项、观察性研究39项、诊断试验17项、病因学/相关因素研究12项、基础科学研究10项、筛查2项。地域覆盖20个省级行政区，涉及74家临床试验机构，招募总样本量314,445例。经费来源主要为地方财政31项、自筹26项、医院资助经费23项等。研究设计最多的为随机平行对照试验，其中仅7项研究使用盲法。干预措施主要有中医药相关治疗、抗血管内皮生长因子治疗联合玻璃体切割术、不同形式玻璃体切割术、全视网膜光凝术等。结论 我国DR注册临床试验呈多样化特点，中医药参与治疗DR特色明显。近年来我国DR临床试验注册数量呈明显上升趋势，但存在注册地区不均衡、资料不完整、以及研究设计欠严谨规范等不足。     

贝叶斯统计与中医药临床试验

统计思想在医学临床研究中具有重要意义,贝叶斯统计更灵活、直观、易于理解,伴随着其理论和相关技术的不断成熟和发展,该方法在临床研究中的应用越来越广泛。目前,国外已开展了很多贝叶斯临床试验,但国内鲜见贝叶斯统计在临床研究中的应用。本文作者从贝叶斯统计的基础理论出发,展开对贝叶斯临床试验的认识,结合中医药临床研究的一些特点,对在中医药研究中开展贝叶斯临床试验提出思考和展望。     

Methods for development of a core outcome set for clinical trials integrating traditional Chinese medicine and Western medicine

Clinical trial outcome reporting differs between studies integrating traditional Chinese medicine (TCM) and Western medicine, so that some clinical trials are not eligible for inclusion in a systematic review. The excluded studies are therefore less widely disseminated, and even valid studies are less likely to yield impact. This problem may be addressed by developing core outcome sets (COSs) for integrative medicine in specific healthcare areas. The first stage of development is to define the scope of the COS for integrative medicine, the second stage is to establish the need for such a COS, and the third stage is to develop a protocol and register the COS. The final stage involves three steps: (i) development of a comprehensive list of outcomes (including efficacy outcomes and safety outcomes and TCM syndromes) using systematic review, qualitative or cross-sectional research, and reviews of package inserts and medical records; (ii) merging and grouping of outcomes within domains; (iii) conducting two rounds of Delphi survey and consensus meetings with a range of stakeholders. The final COS will include a general COS and core TCM syndrome- set. Development of COSs for clinical trials of integrative medicine may help to standardize outcome reporting and reduce publication bias in the future.     

Comparison of effectiveness and safety between granules and decoction of Chinese herbal medicine: a systematic review of randomized clinical trials

Background

The clinical use of Chinese herbal medicine granules is gradually increasing. However, there is still no systematic review comparing the effectiveness and safety of granules with the more traditional method of herbal decoctions.

Method

A literature search was conducted using China National Knowledge Infrastructure Databases (CNKI), Chinese Science and Technology Periodical Database (VIP), China Biomedical Database web (CBM), Wanfang Database, PubMed, and the Cochrane Library until March 10, 2011. Clinical controlled trials (CCTs) including randomized trials (RCTs) comparing the effectiveness and safety between Chinese herbal medicine granules and decoction were included. Two authors conducted the literature searches, and extracted data independently. The assessment of methodological quality of RCTs was based on the risk of bias from the Cochrane Handbook, and the main outcome data of trials were analyzed by using RevMan 5.0 software. Risk ratio (RR) or mean difference (MD) with a 95% confidence interval (CI) were used as effect measure.

Results

56 clinical trials (n = 9748) including 42 RCTs and 14 CCTs were included, and all trials were conducted in China and published in Chinese literature. 40 types of diseases and 15 syndromes of traditional Chinese medicine (TCM) were reported. Granules were provided by pharmaceutical companies in 13 trials. The included RCTs were of generally low methodological quality: 7 trials reported adequate randomization methods, and 2 of these reported allocation concealment. 10 trials used blinding, of which 5 trials used placebo which were delivered double blind (blinded participants and practitioners). 98.2% (55/56) of studies showed that there was no significant statistical difference between granules and decoctions of Chinese herbal medicine for their effectiveness. No severe adverse effects in either group were reported.

Conclusions

Due to the poor methodological quality of most of the included trials, it is not possible to reach a definitive conclusion whether both Chinese herbal medicine granules and decoctions have the same degree of effectiveness and safety in clinical practice, but this preliminary evidence supports the continued use of granules in clinical practice and research. Standardization of granules and further more rigorous pharmacological, toxicological and clinical studies are needed to demonstrate the equivalence with decoctions.     

中西医结合临床试验研究概述与理性思考

本文基于文献研究,对1949年至今的中西医结合临床试验研究内容,从思路方法学角度进行了系统梳理,并对其研究目标、路径进行了深入分析论证,在此基础上作者对未来的中西医结合临床试验研究发展目标及途径进行了理性思考。作者认为,其未来研究目标是要为西医增加新内容,为制定合理的针对某一疾病的中西医结合治疗方案提供科学依据。其可行的研究途径是,针对某种具体疾病整理中医的有效经验,与西医的疗效进行比较,分析二者的优劣和差异,然后对此进行解析,在解析中寻求新发现,产生新认识和新技术,并寻找中西医结合的合理方案。     

Guidelines for randomised controlled trials investigating Chinese herbal medicine

Ethnographic relevance

Clinical trials investigating Chinese herbal medicine (CHM) have been frequently criticised for their lack of scientific rigour. As part of the GP-TCM project a team of experienced clinical researchers and CHM practitioners have developed clinical trial guidelines for CHM that combine an appreciation for traditional methods of practice with detailed and practical advice on research methodology.

Materials and methods

This paper presents an executive summary of this work. It introduces the practice of CHM and the key considerations that need to be addressed whilst researching this traditional medical system.

Results

These guidelines emphasise the importance of identifying best practice, and then developing and applying appropriate and rigorous research methodologies to investigate CHM as a whole system.

Conclusions

It is hoped that this will encourage a thoughtful and meticulous process of investigation that will clarify the contribution that CHM can make to our future healthcare. Innovative new approaches are considered including the application of the new “omic” technologies and systems biology as a way of enhancing our understanding of traditional practice     

The aqueous crude extract of Montanoa frutescens produces anxiolytic-like effects similarly to diazepam in Wistar rats: Involvement of GABA(A) receptor

Ethnopharmacological relevance

Fufangkushen colon-coated capsule (FCC) was a newly developed herbal drug for treating ulcerative colitis (UC) patients with traditional Chinese medicine (TCM) pattern of damp-heat accumulating in the interior.

Objective

To explore the efficacy and safety of FCC in the treatment of active UC compared with Huidi (HD, mesalazine enteric-coated tablets) were evaluated in a double-blinded and randomized clinical trial.

Materials and Methods

In the double-blind, double-dummy, multicenter, randomized and controlled study, 320 active UC patients with TCM pattern of damp-heat accumulating in the interior were assigned to two groups: 240 treated with FCC plus HD placebo treatment, 80 with HD plus FCC placebo. The drugs and their corresponding placebos were administrated at advised dosage for 8 weeks. The primary endpoint was a positive clinical response at week 8, and Mayo scoring system was employed for assessment of UC activity.

Results

At the 8th week, 72.50% of patients in FCC group (170 of 234) and 65.00% of patients in HD group (52 of 80) had achieved a clinical response. There was no statistically significance between the 2 groups (P > 0.05). The proportions of patients who had a clinical remission was similar in 2 groups (41.50% in FCC group, 41.25% in HD group, P > 0.05), mucosal healing rate at week 8 in the two groups were also without significant difference (55.13% in FCC group, 55.00% in HD group, P > 0.05). Mayo scores at week 8 showed no statistically difference in the two groups. No significant differences were observed between the safety profiles of the 2 groups (P > 0.05). No severe AEs were reported in either group. The latent class analysis indicated that FCC was superior applicable for the left hemicolon involved patients than HD.

Conclusions

Compared with HD, a mesalamine enteric-coated tablet, FCC is similarly effective and safe in the treatment of active UC with TCM pattern of damp-heat accumulation interior pattern. In addition, FCC indicates superior effect in the treatment of UC with inflamed area of the left hemicolon than HD.     

解释性RCT和实用性RCT在中医药临床研究中应用比较

临床疗效是中医药学生存和发展的基础,科学评价中医药的临床疗效,对推动中医药现代化、国际化具有重要意义。循证医学为中医药的临床研究带来机遇,随机对照试验(RCT)作为偱证医学I级证据,目前应用于卫生保健的RCT主要为解释性RCT和正在兴起的实用性RCT。对实用性RCT和解释性RCT从试验环境、受试者选择、研究者选择、方案设计和结局评价等方面在中医药临床研究中的适应性和缺陷性逐一进行讨论。     

国外重点针灸临床试验文献的研究机构调查

从文献角度,以MEDLINE和EMBASE数据库为基础,通过文献计量的方法,对国外开展针灸临床试验研究的机构进行计量统计,筛查发文量相对较多的机构,作为今后我国针灸对外交流与合作的重点对象,为促进中医药的科研国际化提供情报支持。