针灸治疗纤维肌痛综合征的临床证据

Survey on Clinical Evidence of Acupuncture Therapy for Fibromyalgia Syndrome

目的:通过对针灸治疗纤维肌痛综合征相关文献的整理评价,提炼出高质量的临床证据,以便于临床医师做出科学的决策。方法:全面检索相关文献,按照循证医学分级标准从高到低选出能够回答对应临床问题的证据,并采用RevMan 5.0统计结局指标。结果:尚未获得证据证明针灸治疗纤维肌痛综合征的有效性;有1项A级证据证明针刺可能优于阿米替林,1项C级证据证明针刺可能优于布洛芬;1项B级证据表明针刺配合西药可能优于单用西药;1项C级证据证明激光照射优于传统针刺。结论:针灸治疗纤维肌痛综合征的疗效优于西药,若配合西药治疗可达增效之功,但仍需更多大样本、多中心的临床试验或系统评价/Meta分析证明。

Objective To evaluate the clinical effect of acupuncture therapy for fibromyalgia syndrome （FMS） by analy- zing the available studies so as to provide clinical decision-making reference. Methods The published papers on clinical trails for acupuncture treatment of FMS were widely retrieved from Chinese Biomedical Databases （1979 - 2010）, www. cnki. net （1979-2010）, VIP China Scientific Journal Database （ 1989 - 2010）, Digital Periodicals on Wanfang Data （ 1998 - 2010）, PubMed （1966-2010）, etc. and by using key words of fibromyalgia syndrome and acupuncture. According to criterion of evidence-based medicine, the evidence from high to low quality levels was selected to answer corresponding clinical questions, and software RevMan 5.0 was used to analyze the final results. Results There has been no enough clinical evidence showing definite efficacy of acupuncture for FMS. However, a LeveI-A study （being in line with conditions of large sample, multi-centers, randomized controlled trails） and a level-C study （having control group, but without distinct randomizing method） showed respectively that acupuncture might be superior to Amitriptyline and Brufen in relieving FMS. Moreover, a piece of evidence that acupuncture combined with western medicine was superior to western medicine alone was allocated to a leveI-B （having correct randomizing method and control group）. Finally, only a level-C evidence proved that laser irradiation on acupoint might be superior to traditional acupuncture in improving FMS. Conclusion Acupuncture for FMS has a positive effect, and acupuncture combined with western medicine can strengthen the curative effect. However this conclusion should be proved further by randomized controlled double blind clinical trials with large samples.