针灸治疗癌因性疲乏的系统评价再评价

Acupuncture and Moxibustion Treatment of Cancer-Related Fatigue:An Overview of Systematic Reviews

目的评估现阶段针灸治疗癌因性疲乏(Cancer-related fatigue,CRF)的系统评价/Meta分析(Systematic reviews/meta-analyses,SRs/MAs)的研究质量,为未来的研究提供思路。方法检索8个中英文数据库收录的针灸治疗CRF的SRs/MAs,检索时限均为建库至2022年2月。运用AMSTAR 2、PRISMA及GRADE评价工具,综合评估纳入MAs/SRs的报告质量、方法学质量和证据质量。运用Excel(Microsoft Office Excel)2016绘制雷达图综合分析结果。结果最终纳入SRs/MAs16篇,主要结局指标为疲乏程度,其中12篇文献结果显示针刺能有效缓解CRF。PRISMA得分在16.0-24.0分的有12篇,得分在15.0-20.5分的有4篇,主要在方案注册和研究间偏倚方面存在缺陷。AMSTAR 2评价有高质量研究4篇,中等质量研究10篇,低等质量研究2篇。GRADE评级显示,针灸治疗CRF的证据质量多为中等,降级的最主要因素为不精确性。结论目前针灸治疗CRF的SRs/MAs报告完整度较高,方法学及证据质量中等。建议将来的SRs/MAs完善方案注册及资助来源说明,增强对研究间偏倚风险的评估。

Objective Due to the increasing number but unknown quality of the existing systematic reviews meta-analyses(SRs/MAs)of acupuncture and moxibustion in the treatment of cancer-related fatigue(CRF),this overview aimed to systematically evaluate and synthesize these SRs/MAs.Methods SRs/MAs were searched via 8 databases from inception to February 22,2022.AMSTAR 2,PRISMA and GRADE evaluation tools were used to evaluate the quality of reports,methodologies and evidence included in MAs/SRs.All analyses were performed with radar plots.Results 16 SRs/MAs were included.The main outcome index was the degree of fatigue.The results of 12 articles showed that acupuncture could effectively alleviate CRF.According to AMSTAR-2,4 SRs/MAs were considered being of high quality,10 medium quality and 2 low quality.There are 12 articles with PRISMA score of 16-24 and 4 articles with PRISMA score of 15-20.5,which mainly have defects in protocol registration and inter study bias.Amstar 2 evaluation includes 4 high-quality studies,studies.Grade rating shows that the evidence quality of acupuncture treatment of CRF is mostly medium,and the main factor of degradation is inaccuracy.Conclusions At present,the SRS/MAS report of acupuncture and moxibustion in the treatment of CRF is complete,and the quality of methodology and evidence is medium.It is suggested that SRS/MAS improve the program registration and funding source description in the future to enhance the assessment of the risk of inter study bias.