针灸治疗消化性溃疡的Meta分析

A meta-analysis of randomized controlled trials assessing eff icacy and safety of acupuncture and moxibustion in the treatment of peptic ulcer

目的:评价针灸治疗消化性溃疡(胃溃疡、十二指肠溃疡)的有效性和安全性,分析临床研究的现状.方法:检索万方数据库、VIP数据库、CNKI数据库、Pubmed数据库及手工检索,纳入针灸治疗消化性溃疡与常规药物比较的随机对照试验(RCT)和临床对照试验(CCT),根据Jadad评分标准评价纳入研究项目的质量.采用RevMan4.2统计软件进行分析.结果:10项研究符合纳入标准,共计1122例患者.Meta分析显示针灸治疗消化性溃疡与常规药物治疗总有效率比较,差异有统计学意义[合并RR(固定效应模型)=1.10,95%CI:1.05-1.16,Z=4.02,P<0.0001];针灸治疗与常规药物幽门螺杆菌转阴率比较,差异有统计学意义[合并RR(固定效应模型)=1.12,95%CI:1.03-1.21,Z=2.71,P=0.007];针灸治疗与常规药物胃镜下溃疡面积愈合有效率比较,差异无统计学意义[合并RR(固定效应模型)=1.02,95%CI:0.97-1.08,Z=0.75,P=0.45];针灸治疗与常规药物复发率比较,差异有统计学意义[合并OR(固定效应模型)=0.42,95%CI:0.24-0.74,Z=3.05,P=0.002].结论:针灸治疗消化性溃疡的近期和远期疗效肯定,但由于纳入的CCT和RCT研究少,高质量、大样本、多中心的随机对照研究更少,因此还不能得出完全肯定的结论,尚需高质量证据来进一步验证.

AIM： To evaluate the efficacy and safety of acupuncture and moxibustion in the treatment of peptic ulcer （gastric and duodenal ulcers）. METHODS： The Wan Fang, VIP, CNKI and PubMed databases were searched to retrieve randomized controlled trials RCTs assessing the efficacy and safety of acupuncture and moxibustion versus conventional therapy in the treatment of peptic ulcer. The quality of the included studies was evaluated Statistical analysis was Man 4.2. using the Jadad score. carried out using Rev-RESULTS： Ten studies involving a total of 1 122 patients were included. The results of meta- analysis showed significant differences between patients undergoing acupuncture and moxibustion and those undergoing conventional therapy in terms of total response rate [total RR = 1.10, 95%CI （1.05, 1.16）, Z = 4.02, P 〈 0.0001], conversion rate from H.pylori positive to negative status [total RR = 1.12, 95%CI （1.03, 1.21）, Z = 2.71, P = 0.007], and recurrence rate [total OR = 0.42, 95%CI （0.24,0.74）, Z = 3.05, P = 0.002], but demonstrated no significant difference in the healing efficiency between the two groups [total RR = 1.02, 95%CI （0.97, 1.08）, Z = 0.75, P = 0.45]. CONCLUSION： Acupuncture and moxibustion are effective in the treatment of peptic ulcer in the immediate and long term.