PDF(Pubmed)
Abstract：
Lumbar disc herniation (LDH) is often managed surgically. Enzymatic chemonucleolysis emerged as a non-surgical alternative. This systematic review and meta-analysis aims to assess the efficacy and safety of chemonucleolytic enzymes for LDH. The primary objective is to evaluate efficacy through \"treatment success\" (i.e., pain reduction) and severe adverse events (SAEs) rates. Additionally, differences in efficacy and safety trends among chemonucleolytic enzymes are explored. Following our PROSPERO registered protocol (CRD42023451546) and PRISMA guidelines, a systematic search of PubMed and Web of Science databases was conducted up to July 18, 2023. Inclusion criteria involved human LDH treatment with enzymatic chemonucleolysis reagents, assessing pain alleviation, imaging changes, and reporting on SAEs, with focus on allergic reactions. Quality assessment employed the Cochrane Source of Bias and MINORS tools. Meta-analysis utilized odds ratios (OR) with 95% confidence intervals (CI). Among 62 included studies (12,368 patients), chemonucleolysis demonstrated an 79% treatment success rate and significantly outperformed placebo controls (OR 3.35, 95% CI 2.41-4.65) and scored similar to surgical interventions (OR 0.65, 95% CI 0.20-2.10). SAEs occurred in 1.4% of cases, with slightly higher rates in chymopapain cohorts. No significant differences in \"proceeding to surgery\" rates were observed between chemonucleolysis and control cohorts. Limitations include dated and heterogeneous studies, emphasizing the need for higher-quality trials. Further optimization through careful patient selection and advances in therapy implementation may further enhance outcomes. The observed benefits call for wider clinical exploration and adoption. No funding was received for this review.
摘要：
腰椎间盘突出症（LDH）通常通过手术治疗。酶化学核溶解术是一种非手术方法。本系统综述和荟萃分析旨在评估化学核酸分解酶对LDH的疗效和安全性。主要目标是通过“治疗成功”(即，疼痛减轻）和严重不良事件（SAE）发生率。此外,探讨了化学核酸分解酶在疗效和安全性趋势上的差异.根据我们的PROSPERO注册协议（CRD42023451546）和PRISMA指南，截至2023年7月18日，对PubMed和WebofScience数据库进行了系统搜索。纳入标准涉及用酶化学核酸溶解试剂治疗人LDH，评估疼痛缓解，成像变化,并报告SAE，专注于过敏反应。质量评估采用Cochrane偏差源和MINORS工具。Meta分析利用比值比(OR)和95%置信区间(CI)。在纳入的62项研究（12,368例患者）中，化学核溶解术显示79%的治疗成功率,显著优于安慰剂对照组(OR3.35,95%CI2.41-4.65),评分与手术干预相似(OR0.65,95%CI0.20-2.10).严重不良事件发生在1.4%的病例中，木瓜蛋白酶队列中的比率略高。化学核溶解和对照组之间的“进行手术”率没有显着差异。局限性包括过时的和异质的研究，强调需要更高质量的试验。通过仔细的患者选择和治疗实施的进展进一步优化可以进一步增强结果。观察到的益处需要更广泛的临床探索和采用。这次审查没有收到任何资金。
