针灸治疗干眼的系统评价

Acupuncture therapy in treating Keratoconjunctivitis Sicca: A systematic review

目的系统评价针灸治疗干眼的疗效。方法运用计算机检索和手工检索相结合的方法，检索中文文献选用中国学术期刊全文数据库（CNKI）、万方中文科技期刊全文数据库、中文科技期刊数据库（VIP）、中国生物医学文献数据库；外文文献选用PubMed数据库。收集国内外2004年1月～2012年12月间公开发表的有关针灸疗法治疗干眼的临床研究文献。由2名评价者独立选择试验、提取资料和评估方法学质量后，采用RevMan5．1版软件进行Meta分析。结果按照筛选标准．共有12篇随机对照临床试验文献694例干眼患者纳入分析。其Meta分析结果显示，针灸治疗组较对照组更能改善眼部症状积分，两组治疗前后症状积分差值相比差异有统计学意义（SMD针灸治疗=-0．63，95％CI[-0．91，-0．35]，P〈0．00001）；针灸治疗组较对照组更能增加泪液分泌量，两组治疗前后泪液分泌量的差值相比差异具有统计学意义（SMD针灸治疗=1．27，95％CI[0．79，1．76]，P〈0．00001）；针灸治疗组较对照组更能延长泪膜破裂时间，两组治疗前后泪膜破裂的差值相比差异具有统计学意义（SMD针灸镕疗=0．87，95％CI[0．51，1．231，P〈0．00001）；在改善荧光素角膜染色积分方面，两组之间没有明显差别（SMD针灸治疗=0．01，95％CI[-0．24，0．261，P=0．96）；在总有效率方面针刺治疗组优于对照组，差异有统计学意义（SMD针灸治疗=-0．63，95％C1[-0．91，-0．35]，P〈0．00001）。结论针灸治疗干眼的疗效优于人工泪液治疗。

OBJECTIVE To evaluate the effectiveness of acupuncture treatment for keratoconjunctivitis sic- ca. METHODS The databases such as PubMed, CNKI, VIP and WanFang Data were searched for collecting ran- domized controlled clinical trials which used acupuncture therapy for treating keratoconjunetivitis sicca from the date of Jan 2004 to Dee 2012. Studies were screened, data were extracted and the methodological quality was as- sessed by two reviewers independently. We used RevMan 5.1 software to complete Meta-analyses. RESULTS Twelve trials involving 694 patients were included. Meta-analysis showed that acupuncture therapy could increase the difference of ocular surface symptom index between pre-treatment and post-treatment （SMD=-0.63,95%CI[-0.91, -0.35],P〈0.000 01 ） compared with artificial tears. The meta analysis indicated that acupuncture therapy had in- creased the tear output before and after treatment compared with artificial tears significantly （SMD=1.27,95% CI [0.79,1.76],P〈0.000 01）. It also indicated that acupuncture therapy could increase the difference of tear film break-up time between pre-treatment and post-treatment （SMD=0.87,95%CI[0.51,1.23], P〈0.000 01 ） compared with artificial tears. The meta analysis indicated that acupuncture therapy could not increase the range of corneal fluores- eein staining scores change before and after treatment compared with artificial tears significantly （SMD=0.01,95%CI [-0.24,0.26], P=0.96）. It also indicated that acupuncture therapy could increase the overall effect rate between pre- treatment and post-treatment （SMD =0.87,95% CI [0.51,1.23], P〈0.000 01 ） compared with artificial tears. CONCLUSIONS According to evidences, acupuncture therapy could relieve Keratoeonjunctivitis Sicca patients＇ ocular symptom significantly compared with artificial tears. More specifically, acupuncture therapy could improve the quality of tears as well as the increase of tear output.