针灸治疗湿疹的系统评价

Systematic Review of Acupuncture Treatment for Eczema

目的评价针灸治疗湿疹的临床疗效。方法计算机检索CENTRAL、Medline、AMED、CNKI、VIP和万方数据库,查找所有有关针灸治疗湿疹的随机对照试验(RCT),检索时限均为建库至2013年7月13日。同时手检纳入文献的参考文献。按纳入与排除标准,由两名研究者独立进行RCT的筛选、资料提取和质量评价后,采用Revman5.2软件进行Meta分析,并采用GRADE系统进行证据质量评价。结果共纳入5个研究,335例患者。Meta分析结果显示,1有效率,其中针灸与西药比较,结果显示两组间有统计学意义[RR=1.21,95%CI=(1.08,1.37)];针灸+西药与西药比较,结果显示两组间无统计学意义[RR=1.05,95%CI=(0.83,1.33)]。2瘙痒介质组胺的血清水平检测,其中针灸与西药比较,结果显示两组无统计学意义[MD=0.42,95%CI=(0.16,0.68)];针灸+西药与西药比较,结果显示两组无统计学意义[MD=0.03,95%CI=(﹣0.26,0.32)]。3瘙痒介质白三烯B4的血清水平检测,其中针灸与西药比较,结果显示两组无统计学意义[MD=3.52,95%CI=(2.14,4,90)];针灸+西药与西药比较,结果显示两组无统计学意义[MD=1.25,95%CI=(﹣0.20,2.70)]。4瘙痒程度、皮损形态、皮损面积评分,针灸+中成药与中成药比较治疗湿疹瘙痒程度、皮损形态、皮损面积评分,结果显示两组有统计学意义[MD=﹣2.67,95%CI=(﹣3.57,﹣1.77)]。5嗜酸性粒细胞计数,针灸+中成药与中成药比较治疗湿疹嗜酸性粒细胞计数,结果显示两组无统计学意义[MD=﹣0.01,95%CI=(﹣0.18,0.16)]。基于系统评价结果,采用GRADE系统推荐分级方法评价证据质量,结果显示,证据水平均为低级,推荐强度为弱推荐。结论针灸能提高湿疹治疗的有效率,但因原始研究的质量均较低,需要更多高质量、大样本的RCT进一步论证。

Objective CENTRAL, Medline, AMED, CNKI, VIP and Wanfang databases were searched using a computer for randomized controlled Trials （RCT） of acupuncture treatment for eczema. Search time limit was from the date of database establishment to Jul. 13rd, 2013. Meanwhile, the references of included literature were found by hand searching. After RCT selection, quality assessment and data extraction were performed by two independent reviewers according to inclusion and exclusion criteria, Meta analysis was made using RevMan5.2 software, and the level of evidence and methodological quality were assessed using the GRADE system. Results Five studies involving 335 patients were included. The results ofmeta-analyses showed that 1） there was a statistically significant difference in the efficacy rate between acupuncture and Western drug groups [RR=1.21, 95%CI= （ 1.08, 1.37）] and no statistically significant difference between acupuncture plus Western drug and Western drug groups [RR=1.05, 95%CI= （0.83, 1.33）] ; 2） there was no statistically significant difference in serum pruritus mediator histamine level between acupuncture and Western drug groups [MD=0.42, 95%CI= （0.16, 0.68）] and between acupuncture plus Western drug and Western drug groups [MD=O.03, 95%CI= （-0.26, 0.32）] ; 3） there was no statistically significant difference in serum pruritus mediator leukotrienes B4 level between acupuncture and Western drug groups[MD=3.52, 95%CI=（2.14, 4,90） land between acupuncture plus Western drug and Western drug groups [MD=1.25, 95%C1= （-0.20, 2.70）1 ; 4） there were statistically significant differences in post-treatment eczematous pruritus severity, skin lesion form and skin lesion area scores between acupuncture plus Chinese patent drug and Chinese patent drug groups [MD=-2.67, 95%CI= （-3.57, -1.77）] ; 5） there was no statistically significant difference in posttreatment eosinophil count between acupuncture plus Chinese patent drug and Chinese patent drug groups [MD=-0.01, 95%CI= （-0.18, 0.16）] . On the basis of the results of systematic review, the level of evidence and methodological quality were assessed using the recommended classification method of GRADE system. The results showed that the level of evidence was low and the strength of recommendation was weak. Conclusion Acupuncture can raise the efficacy rate in treating eczema. More high-quality and large-sample RCTs are required for further validation because the quality of the original studies is low.