刺络放血疗法治疗偏头痛疗效的Meta分析

A Meta-analysis on Pricking Blood Therapy for Migraine

目的:系统评价刺络放血疗法治疗偏头痛的有效性。方法:电子检索中国学术文献总库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、Ovid数据库、Science Direct数据库、Socolar数据库、Sci Finder(美国化学文摘)及FMJS(西文生物医学期刊文献数据库)中有关刺络放血疗法治疗偏头痛的文献,按拟定标准对原始文献进行筛选并对符合纳入标准的研究进行质量评价,采用Review Manager 5.1软件进行Meta分析。结果:纳入研究11项,包含病例826例,其中仅3项为高质量研究,另8项均为低质量研究。Meta分析结果显示刺络放血组与对照组比较,有效率结果 OR合并=6.23,其95%CI为(4.03,9.63),合并效应量的检验Z=8.24,P<0.00 001,差异有统计学意义,提示刺络放血组治疗偏头痛疗效优于对照组。而分析所得漏斗图对称度欠佳,提示Meta分析结果存在偏倚的可能。结论:Meta分析的结果为刺络放血疗法在偏头痛治疗中的优势提供证据,但由于纳入研究质量普遍不高以及偏倚等因素,尚待临床更多大样本、高质量、方法学规范化的随机对照研究的实施,以期经过系统评价后作为可靠证据指导偏头痛的治疗。

Objective To evaluate the therapeutic effect of pricking blood therapy for migraine. Methods We searched all the original papers about pricking blood therapy for migraine in common databases as the Chinese National Knowledge Infrastructure Database （CNKI）, Chinese Biomedical Library （CBM）, Ovid, Science Direct, Socolar, and Sci Finder （1949 -2012）, Wanfang Data （1998-2012） and Foreign Medical Journal Service （FMJS, 1990-2012）. The original articles were searched in accordance with a predefined standards （simple pricking blood treatment, or the pricking blood therapy was the principal approach）, while those about other diseases （such as cerebrovascular disease, cervical spondylosis, etc. ） evoked migraine, pricking blood used as a complementary therapy, case report, specialists＇ experience summary, reviews, surveys, news articles, animal studies were excluded. Then, a Meta-analysis was made by software Review Manager 5. 1. Results A total of 11 clinical trial papers involving 826 cases of migraine were included in the present paper. Three of them were high-quality researches, and the other eight were low quality researches. Results of Meta-analysis indicated that the therapeutic effect of the pricking blood therapy was significantly superior to that of non-bleeding therapies in relieving migraine [OR = 6.23, 95 % CI ： （4.03, 9.63）, Z = 8.24, P〈0.00 001]. However, the poor symmetry of funnel plot suggested a risk of bias. Conclusion The pricking blood therapy is effective for relieving migraine, but larger sample clinical trials, particularly randomized controlled trials are definitely needed for confirming the conclusion.