针灸治疗哮喘随机对照临床研究文献Meta分析

Meta-analysis on randomized controlled clinical trials of acupuncture for asthma

目的:评价针灸治疗哮喘的有效性。方法:计算机检索2000-2009年重庆维普、中国知网、PubMed、HighWire数据库关于针灸治疗哮喘的临床研究文献,选择符合要求的随机对照试验(RCT)、临床对照试验(CCT)文献进行Meta分析。结果:共纳入22篇文献,合计3058例哮喘患者,分析发现针灸治疗哮喘的总有效率优于对照组[OR=4.18,95%CI(3.36,5.20),Z=12.85,P<0.00001];第1秒末用力呼气量(FEV1)的两组间比较不具有统计学意义[OR=0.20,95%CI(-0.37,0.76),Z=0.68,P=0.50];治疗后最大呼气流速(PEFR)测量结果的两组间比较差异具有统计学意义[OR=0.42,95%CI(0.22,0.62),Z=4.06,P<0.0001];治疗后用力肺活量(FVC)测量结果的两组间比较差异具有统计学意义[OR=0.45,95%CI(0.17,0.72),Z=3.22,P=0.001];治疗后FEV1/FVC测量结果的两组间比较差异具有统计学意义[OR=9.58,95%CI(8.14,11.02),Z=13.03,P<0.00001]。结论:针灸疗法能够显著提高哮喘治疗的总有效率,PE-FR、FVC、FEV1/FVC能够作为哮喘疗效判定的指标,但FEV1却无统计学意义。由于RCT、CCT文献数量过少,特别是高质量、大样本、多中心的随机临床研究报道极少,且文献发表偏倚的存在,因此上述结果还需要进一步深入研究。

Objective To assess the efficacy of acupuncture and moxibustion for asthma by meta-analysis of randomized controlled clinical trials. Methods A literature search in VIP, CNKI, PubMed and HighWire was performed to retrieve clinic trials documents about acupuncture for asthma from 2000 to 2009. The meta-analysis was conducted on RCT and CCT documents that meet the enrolling requirements. Results Twenty-two trials including 3 058 cases of asthma patients were included in this study. The findings indicates that the total effective rate in acupuncture group was significantly superior to control group fOR： 4. 18, 95% CI （3.36, 5.20）, Z=12.85, P〈0. 000 01]; there was no significant difference in FEV1 measurements between two groups fOR=0.20, 95 % CI （-0.37, 0.76）, Z=0. 68, P： 0.50]; there was profound significant difference in PEFR measurements between two groups [OR=0.42, 95% CI （0.22, 0.62）, Z=4.06, P〈0. 000 1]; there was profound significant difference in FVC measurements between two groups [OR=0.45, 95% CI （0.17, 0.72）, Z=3.22, P=0. 001]; there was profound significant difference in FEV1/FVC measurements between two groups [OR = 9.58, 95% CI （8.14, 11.02）, Z= 13.03, P〈0. 000 01]. Conclusion Acupuncture and moxibustion therapy can significantly improve the total effective rate of acupuncture for asthma. PEFR, FVC, FEV1/FVC can be used as effectiveness indicators for evaluating the treatment for asthma. The FEV1 measurements did not have statistic significance. Due to the small number of RCT/CCT documents, the bias of the literatures and the lack of high-quality, large sample and multi-center reports, further studies are needed to explore the evidence of the findings.