针刺治疗紧张性头痛疗效的系统评价

Acupuncture for Tension-type Headache: A Systematic Review

目的 评价针刺治疗紧张性头痛 (tension typeheadache ,TTH)的疗效。方法 计算机检索Cochrane图书馆 (2 0 0 3年第 4期 )、MEDLINE(196 6～ 2 0 0 4. 3)、中国生物医学文献数据库 (CBM) (1978～ 2 0 0 3 .8)、中文科技期刊全文数据库 (VIP) (1989～ 2 0 0 3.4 ) ,手工检索 2 0 0 3年发表的其他相关中文文献。由两名评价者独立对纳入文献进行质量评价并提取资料 ,如遇分歧 ,通过讨论解决。对纳入文献用RevMen 4 . 2进行Meta分析。结果 13篇RCT、共5 71例病人符合纳入标准 ,其中高质量研究 6篇 ,有 8篇应用了假针刺作为对照。Meta分析结果显示 :针刺组与假针刺组比较 ,在治疗结束时有效率的差异无统计学意义 [RR 1.5 5 ,95 %CI (0.97,2.4 7) ,P =0.0 7];VAS评分的合并标准化均数差值显示 ,两组在治疗结束时 ,<2月随访以及 >2月随访的治疗有效率的差异均无统计学意义 ,其WMD(95 %CI)和P值分别为 - 0.5 5 (- 1.2 0 ,0 .0 9) ,P =0. 0 9;- 0. 2 2 (- 0.87,0 .4 2 ) ,P =0. 5 0 ;- 0 . 6 5 (- 0.4 1,0 .11) ,P =0.0 9。结论 目前无足够证据证明针刺与假针刺或其他疗法比较对治疗紧张性头痛更为有效 ,尚需更多设计严谨 ,方法科学的高质量随机对照试验。

Objective To assess the effectiveness of acupuncture for tension type headache Methods A systematic review of the relevant randomized controlled trials (RCTs) of acupuncture for tension type headache was performed using the methods of The Cochrane Collaboration. Trials were collected from The Cochrane Library, Issue 4, 2003, MEDLINE (1966March 2004), CBM (1978August 2003), VIP (1989April 2003) and handsearched all related articles published in Chinese in 2003. The quality of literature was reviewed, and data were extracted by two reviewers independently. Meta analysis was conducted using RevMan 4.2 software. Results Thirteen RCTs involving 571 patients were included, of the thirteen RCTs, six were of high methodological quality according to Jadad scale (the Jadad score≥3), and “sham acupuncture” was used as controlled intervention in eight trials. Meta analysis indicated that no statistical difference was detected between acupuncture and sham acupuncture groups on effectiveness with RR 1.55, 95%CI 0.97 to 2.47 and P=0 07 at the end of treatment. No statistical difference was detected between acupuncture and sham acupuncture groups on visual analogue scale at the end of treatment with WMD -0.55, 95%CI -1.20 to 0.09 and P=0.09; at the end of follow up of less than 2 months with WMD -0.22, 95%CI -0.87 to 0.42 and P= 0.50 and at the end of follow up of more than 2 months with WMD -0.65, 95% CI -1.41 to 0.11 and P=0.09. Conclusions Comparing acupuncture with sham acupuncture and other treatments, current evidence can not evaluate whether acupuncture is significantly effective for tension type headache, more RCTs of high methodological quality are required.