中药穴位贴敷疗法治疗慢性功能性便秘疗效的Meta分析

Acupoint Application Therapy for Chronic Functional Constipation:A Meta Analysis

目的评价中药穴位贴敷疗法治疗慢性功能性便秘患者的疗效和安全性。方法计算机检索PubMed、EMBase、Cochrane图书馆(2013年第12期)、中国生物医学文献数据库、中国知网、维普网和万方数据库,收集采用中药穴位贴敷疗法治疗慢性功能性便秘的随机对照试验,检索时间均为建库至2013年12月。由2位评价者按照文献纳入与排除标准独立提取资料,并根据Cochrane手册5.1.0评价纳入文献质量后采用RevMan 5.1软件进行Meta分析。结果最终纳入15篇文献,包含1 412例患者。15篇文献均未提及盲法的实施情况。15篇文献均报告了有效率,本研究根据不同的干预方式(穴位贴敷与西药、穴位贴敷与中药或中成药、穴位贴敷联合中药或中成药与中药或中成药)进行亚组分析,Meta分析结果显示各亚组分析中试验组有效率均高于对照组〔RR(95%CI)=1.32(1.00,1.75),1.20(1.07,1.35),1.33(1.14,1.55),P≤0.05〕。4篇文献报告了复发率,采用固定效应模型进行Meta分析,结果显示试验组的复发率低于对照组,差异有统计学意义〔RR=0.50,95%CI(0.34,0.74),P=0.0006〕。5篇文献描述了不良反应的发生情况,采用固定效应模型进行Meta分析,结果显示两组的不良反应发生情况间差异无统计学意义〔OR=1.67,95%CI(0.38,7.29),P=0.49〕。结论中药穴位贴敷疗法治疗慢性功能性便秘安全有效。但受纳入文献质量的限制,本研究尚不能得到较为可靠的结论。

Objective To evaluate the efficacy and safety of point application therapy with herbs for chronic functional constipation（ CFC）. Methods This study retrieved PubMed,EMBase,The Cochrane Library,CBM,CNKI,VIP and WanFang Data for randomized controlled trials of herb acupoint application in CFC treatment from establishment to December 2013.Two valuators extracted data independently according to the inclusion and exclusion,evaluated the quality of the enrolled literatures and underwent Meta analysis by ReyMan 5. 1 software. Results A total of 15 literatures were enrolled including 1 412 cases. Blind method was not mentioned in all 15 literatures. Fifteen literatures reported effective rate. We underwent subgroup analysis according to different interventions（ acupoint application vs Western medicine,acupoint application vs Chinese drugs or Chinese patent medicine,acupoint application combined with Chinese drugs or Chinese patent medicine vs Chinese drugs or Chinese patent medicine）. Meta analysis showed that in each of subgroup analysis,the effective rate was higher in study group than in control group 〔RR（ 95% CI） = 1. 32（ 1. 00,1. 75）,1. 20（ 1. 07,1. 35）,1. 33（ 1. 14,1. 55）,P≤0. 05〕. Four literatures reported recurrence rate. Fixed effect model was used to undergo Meta analysis and the results showed that the recurrence rate was lower in study group than in control group,the difference was significant 〔RR = 0. 50,95% CI（ 0. 34,0. 74）,P = 0. 0006〕. Five literatures reported adverse reactions. Using fixed effect model to undergo Meta analysis showed that there was no significant difference in adverse reaction between 2 groups 〔OR = 1. 67,95% CI（ 0. 38,7. 29）,P = 0. 49〕. Conclusion Acupoint application therapy is safe and effective in treatment of CFC. This study has not gained a more reliable conclusion due to the limited literature quality.