针灸治疗带状疱疹文献质量评价与施治规律探讨

Evaluation of literature quality of acupuncture for treatment of herpes zoster and approach to the laws of treatment

目的:对针灸治疗带状疱疹的临床研究文献进行质量评价。方法:电子检索1994—2006年研究文献。按照临床流行病学和循证医学的原则和方法,对临床研究类型及方法学、一般情况、疾病诊断及纳入和排除标准、样本含量估计、治疗情况、疗效判定标准、随访等方面进行评价。结果:在399篇纳入文献中,真正随机对照试验仅8个;半随机对照试验20个;非随机同期对照试验66个;叙述性研究共277个;明确诊断标准70篇;提及纳入或排除标准的16篇;明确疗效标准的287篇;107篇文献记录随访;2篇描述有卫生经济学指标;9篇文献提及不良反应。结论:目前迫切需要正确实施随机、隐藏及盲法、安慰剂对照、有公认诊断及疗效评价标准、进行安全性评价、合理设计随访的随机对照试验研究。同时通过文献初步探讨针灸治疗带状疱疹的施治规律是以阿是穴刺络放血拔罐为主。

Objective To assess the quality of literature of clinical studies on acupuncture in treatment of herpes zoster. Methods The literatures between 1994-2006 were searched by means of electronic retrieval. Type and methodology, general condition, diagnosis of diseases and enrolled and excluded criteria, assessment of sample content, treatment condition, criteria for assessment of therapeutic effects, following-up, etc. in clinical studies are evaluated according to principles and methods of clinical epidemiology and evidence-based medicine. Results Of the 399 literatures enrolled, only 8 were authentic randomized controlled trials （RCTs）, 20 quasi-randomized controlled trials, 66 non-randomized concurrent controlled trials and 277 narrative studies, 70 had clear diagnostic criteria, 16 mentioned enrolled or excluded criteria, 287 had clear criteria for therapeutic effects, 107 reported follow-up, 2 had the description of health economical index, 9 reported adverse reaction. Conclusion At present, correct randomization, concealment, blinding and placebo-control, and the RCTs with generally accepted criteria for assessment of diagnosis and therapeutic effects, safety evaluation and rational design of follow-up are needed. It is indicated by preliminary study of the literatures that blood-letting puncture and cupping at Ashi points are main methods for treatment of herpes zoster.