针刺治疗慢性疲劳综合征的系统评价

Acupuncture for Chronic Fatigue Syndrome: A Systematic Review

目的系统评价针刺治疗慢性疲劳综合征的有效性和安全性。方法电子检索MEDLINE(1966-2007年)、EMBASE(1984-2007年)、Cochrane图书馆(2007年第4期)、中国生物医学文献数据库(1979-2007年)和截至2007年底的中文全文数据库(CNKI、VIP)。纳入针刺治疗的随机对照试验,对纳入研究的质量进行评价,并进行Meta分析。结果共纳入文献13篇,包括2篇英文文献,所有纳入文献均存在一定方法学缺陷,包括随机方法描述不清、未进行分配隐藏等。与包括中成药、中药汤剂在内的6种不同对照组比较,结果均提示针刺在缓解疲劳症状方面优于对照组。同时,针刺在改善疲劳以外的其他症状包括头痛(相对危险度1.37,95%可信区间1.07～1.75)和肌肉骨骼痛(相对危险度1.74,95%可信区间1.28～2.36)方面疗效优于中成药组。另外,有1个研究提示针刺在改善患者精神状况的2个方面包括恐惧(标准平均差-0.51,95%可信区间-0.94～-0.08)和精神病化(标准平均差-0.92,95%可信区间-1.37～-0.48)疗效优于中成药组。结论针刺对改善慢性疲劳综合征患者的疲劳症状有一定近期疗效,但其疗效和安全性还需要更多的高质量随机对照试验和更长随访时间进一步证实。[关键词]针刺;慢性疲劳综合征;系统评价;

Objective To conduct a systematic review with evidence collected from randomized controlled trials of acupuncture for chronic fatigue syndrome （CFS）. Method We searched the Coehrane Central Register of Controlled Trials （CENTRAL） on the Coehrane Library （Issue 4, 2007）, MEDLINE （1966-2007）, EMBASE （1998-2007）, Chinese Biomedical Database （1979-2007）, CNK1 and VIP. Randomized controlled trials （RCTs） were included. The quality of trials was evaluated and meta-analysis was performed. Results Altogether 13 studies were included, including 2 studies written in English. All included studies had methodological flaws like unclear randomization and absence of allocation concealment. All 6 comparisons concerning fatigue showed that acupuncture was of benefit over different control groups. Among series of symptoms besides fatigue, headache （RR=l.37 with a 95%CI of 1.07 to 1.75） and musculoskeletal pain （RR=l.74 with a 95%CI of 1.28 to 2.36） were found to be positive compared to Chinese patent medicine. Acupuncture was demonstrated to be more effective than Chinese patent medicine on some psychological factors including phobic anxiety （SMD =-0.51 with a 95%CI of-0.94 to -0.08） and psyehotieism （SMD =-0.92 with a 95%CI of -1.37 to -0.48）. This result was limited in the analysis of continuous data from a single trial. Conclusions No firm evidence is obtained to support or refute the use of acupuncture for CFS. There is a need for further well designed clinical trials.