针刺治疗消化性溃疡疗效的系统评价和Meta分析

Systematic Evaluation and Meta-analysis on Acupuncture for Peptic Ulcer

目的:系统评价针刺治疗消化性溃疡的临床疗效。方法:计算机检索中国期刊全文数据库、万方数据库、重庆维普中文科技期刊数据库、中国生物医学文献数据库网络版、PubMed和Cochrane Library,检索从建库(刊)到2016年9月发表的关于针刺治疗消化性溃疡的随机对照试验(RCT),对符合纳入标准的文献进行资料提取和质量评价,应用RevMan 5.3统计软件对纳入的文献进行Meta分析。结果:最终纳入16项RCT,合计1 570例消化性溃疡患者。Meta分析结果显示:(1)针刺与西药比较:在有效率、溃疡面积愈合率、幽门螺杆菌(HP)转阴率方面,差异无统计学意义(P>0.05);在复发率方面,针刺组低于西药组,差异具有统计学意义[RR=0.35,95%CI(0.14,0.84),P<0.05]。(2)针刺+西药与西药比较:在有效率、溃疡面积愈合率、复发率方面,差异均具有统计学意义[RR=1.20,95%CI(1.04,1.38),P=0.01;RR=1.29,95%CI(1.06,1.58),P=0.01;RR=0.27,95%CI(0.16,0.45),P<0.00001]。证据等级分析结果显示,除针刺治疗的溃疡面积愈合率和针刺HP转阴率评为"低级"外,其余都被评为"极低级"。结论:针刺联合西药治疗消化性溃疡对照常规西药具有一定的优势,但该结论的证据质量等级不高,研究结论需谨慎对待,需要大样本、高质量的随机对照试验进行进一步的验证。

Objective To systematically evaluate the clinical efficacy of acupuncture for peptic ulcer. Methods Randomized controlled trials of acupuncture for peptic ulcer were searched from China National Knowledge Infrastructure （CNKI）, WanFang Database, Chinese Scientific and Technological Journals （VIP）, China Biomedicine （CBM）, PubMed and the Cochrane Library from the establishment time of databases to September, 2016. Data extraction and quality evaluation were implemented for the literature which met the inclusive criteria. The RevMan 5.3 software was used to make Meta-analysis. Results Sixteen papers including 1 570 patients of peptic ulcer were included. The results of Meta-analysis showed that there was no statistical significance between acupuncture and western medicine in the effective rate, the healing rate of ulcer area and the HP negative rate （all P〉0.05） ; the recurrence rate of acupuncture was significantly lower than that of western medicine ERR= 0.35, 95% CI （0.14, 0.84）, P〈0. 05]. Acupuncture plus western medicine was significantly different from simple western medicine in the effective rate, the healing rate of ulcer area and the recurrence rate[RR = 1.20,95 % CI （ 1.04, 1.38）, P = 0.01 ; RR = 1.29, 95 % CI （1.06, 1.58）, P=0.01;RR=0.27, 95% CI （0.16, 0.45）, P〈0.00001], The analysis of evidence grade （GRADE） presented that the healing rate of ulcer area and the HP negative rate of acupuncture were ＂low grade＂, and others were ＂extremely low grade＂. Conclusion Acupuncture combined with western medicine has some advantages for peptic ulcer compared with the conventional western medicine, which needs further confirmation due to the lower evidence grade. Larger samples, randomized controlled trials with high quality are highly recommended.