电针夹脊穴治疗腰椎间盘突出症临床随机对照试验系统评价

Systematic Review of Electroacupuncture on Jiaji Points for Treating Lumbar Disc Herniation in Clinical Randomized Controlled Trials

目的:评价电针夹脊穴治疗腰椎间盘突出症的有效性和安全性,分析目前临床研究的现状。方法:检索PubMed、OVID、Cochrane图书馆、CBM-disc数据库、CNKI数据库、VIP数据库、万方数据库以及手工检索,收集电针夹脊穴治疗腰椎间盘突出症的临床随机对照试验文献215篇,其中6篇符合纳入研究标准;Cochrane系统评价手册进行质量评价,并对6篇文献采用RevMan4.2进行Meta分析。结果:6篇文献纳入研究,共772例患者。6篇文献治愈率汇总合并汇总OR值为2.53,95%CI为[1.87,3.42],P<0.01,差异有统计学意义,说明治疗组(采用电针夹脊穴)对腰椎间盘突出症的治愈率高于对照组(采用常规取穴加电针);总有效率汇总OR值为3.61,95%CI为[2.03,6.43],P<0.01,差异有统计学意义,说明治疗组对腰椎间盘突出症的总有效率高于对照组。疼痛指标的判定:其中1篇使用MPQ治疗前后差值作为疗效指标的样本量为82,汇总OR为2.20,95%CI为[0.76,3.64],P<0.01,差异有统计学意义,说明治疗组对腰椎间盘突出症的MPQ治疗前后差值作为疗效指标优于对照组;1篇使用VAS作为疗效指标的样本量为122,OR值为-1.32,95%CI为[-1.33,-1.31],P<0.01,差异有统计学意义,说明治疗组对腰椎间盘突出症的使用VAS作为疗效指标判断疼痛改善程度优于对照组。结论:目前纳入研究显示电针夹脊穴治疗腰椎间盘突出症在治愈率、总有效率方面优于常规取穴加电针,并且安全、有效,但在改善腰椎间盘突出症疼痛程度方面,由于纳入文献的数量太少,尚不能肯定电针夹脊穴具有镇痛的作用,需高质量证据来进一步验证。

Objective：To evaluate the efficacy and safety of electroacupuncture on Jiaji Points in treating lumbar disc herniation and analyze the current status of clinical research. Methods.. Retrieving the PubMed, OVID, Cochrane Library, CBdisc database, CNKI database, VIP database, we collected 215 literature of the manipulation treatment of lumbar disc herniation, with 6 studies met the inclusion criteria. Cochrane systematic review was used to quality evaluation. The 6 studies were used by RevMan 4.2 for Meta analysis. Results：The 6 studies included a total of 772 patients, and the OR of the summary cure rate was 2. 53 and 95% CI was [-1.87, 3.42]. The cure rate in treatment group （treated by electroacupuncture on Jiaji points） was superior to control group （conventional acupoints plus EA） （P〈0.01）. The OR of the summary total effective rate was 3.61 and 95% CI was [2.03, 6.4a], and the total effective rate of treatment group was superior to control group （P〈0.01）. One documents using 82 samples for evaluating efficacy endpoint by analyzing the MPQ difference before and after treatment, summary OR is 2.20 and 95 % CI is [0.76, 3.64], the treatment group was superior to control group （P〈0.01）. One documents using 112 samples for evaluating efficacy endpoint by analyzing the VAS value, summary OR is -1.32 and 95% CI is[-1.33,-1. 311, the treatment group was superior to control group （P〈0.01） in pain improvement of lumbar disc herniation. Conclusion： At present, the documents included in this study have shown that electroacupuncture on Jiaji points for treating lumbar disc herniation is safe and effective, and both cure rate and the effective rate are much better than conventional aeupoints plus EA. But in improving the degree of pain, the effect of electroacpuncture on Jiaji points is still not sure because of the small number of included studies, needed high-quality evidence to further verify.