国内针刺治疗多囊卵巢综合征系统评价

Systematic Review of Acupuncture in Treatment of Polycystic Ovary Syndrome in China

目的系统评价针刺治疗多囊卵巢综合征(PCOS)临床疗效和安全性。方法计算机检索中国知识资源总库(CNKI)、中国学术期刊数据库(万方数据)、中国生物医学文献数据库(CBM)、中文科技期刊数据库(维普网)建库至2017年6月收录的针刺治疗PCOS随机对照试验文献。2名评价员独立按照纳入与排除标准筛选文献、提取资料,采用《Cochrane系统评价员手册》偏倚风险评估工具进行文献质量评价,采用RevMan5.3软件进行Meta分析。结果最终纳入8项研究,共494例受试者。Meta分析结果显示:针刺治疗PCOS在降低黄体生成素[SMD=-0.55,95%CI(-0.76,-0.35)]、睾酮[SMD=-0.72,95%CI(-1.03,-0.41)]、黄体生成素与卵泡刺激素比值[SMD=-0.52,95%CI(-0.90,-0.14)]、体质量指数(BMI)[SMD=-0.38,95%CI(-0.66,-0.10)]方面均明显优于单用西药(P<0.01),在提高有效率[RR=1.04,95%CI(0.94,1.16),P=0.44]、降低卵泡刺激素[SMD=-0.09,95%CI(-0.31,0.12),P=0.40]方面与单用西药疗效相当。结论针刺治疗PCOS临床疗效确切,且安全性较好。由于纳入研究样本量较少,质量普遍偏低,尚需要大样本、多中心、高质量随机对照研究支持。

Objective To evaluate the efficacy and safety of acupuncture in the treatment of polycystic ovarian syndrome (PCOS).Methods Databases as CNKI,Wanfang Data,CBM and VIP,etc.were searched to collect randomized controlled trials about acupuncture in the treatment of PCOS from the establishment of the databases to June 2017.Two reviewers independently screened and extracted data according to inclusion and exclusion criteria,and used the Cochrane Reviewers's Handbook bias risk assessment tool for literature quality evaluation.RevMan5.3 software was used to conduct Meta-analysis.Results Totally 8 articles involving 494 patients were included eventually.The results of Meta-analysis showed that compared with Western medicine alone,acupuncture had better efficacy in reducing LH [SMD=-0.55,95%CI (-0.76,-0.35)],testosterone [SMD=-0.72,95%CI (-1.03,-0.41)],LI-I/FSH Ratio [SMD=-0.52, 95%CI (-0.90,-0.14)]and BMI [SMD=-0.38,95%CI (-0.66,-0.10)].Acupuncture had the same efficacy in improving effective rate [RR=I.04,95%CI (0.94,1.16),P=0.44]and decreasing FSH [SMD=0.09,95%CI (-0.310.12),P=0.40] as Western medicine alone.Conclusion Acupuncture in the treatment of PCOS has confirmed clinical efficacy,with high safety.Due to the small sample size and the generally low quality of included studies,this conclusion still needs support from large sample,multi-center,high-quality randomized controlled research.