耳穴贴压治疗失眠疗效的Meta分析

Effectiveness of auricular point therapy for insomnia:a meta analysis

目的系统评价耳穴贴压治疗失眠的疗效,为失眠患者的治疗提供参考。方法计算机检索PubMed、Cochrane Library、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普期刊资源整合服务平台(VIP)和万方数据知识服务平台(WanFang Data)等数据库中有关耳穴贴压治疗失眠的随机对照试验(RCT),追溯纳入文献的参考文献,文献检索时限为各数据库建库至2014年9月。按照纳入和排除标准筛选文献、提取资料并评价纳入研究的方法学质量后,采用RevMan 5.0软件进行Meta分析。结果共纳入7篇RCT,合计939例受试者。根据干预时间和对照组的干预方案进行亚组分析。Meta分析结果显示:1以干预时间为亚组分析:干预2周,耳穴贴压组的总有效率高于对照组[OR=10.66,95%CI(5.23,21.74),P<0.01];干预1个月,耳穴贴压组的总有效率高于对照组[OR=4.54,95%CI(2.28,9.01),P<0.01]。2以对照组治疗方案为亚组分析:与针刺组相比,耳穴贴压组总有效率高于针刺组[OR=7.70,95%CI(3.05,19.48),P<0.01];与药物组相比,耳穴贴压组总有效率高于药物组[OR=7.76,95%CI(4.61,13.08),P<0.01]。结论耳穴贴压治疗失眠有一定疗效,可提高患者的睡眠质量。但由于本次纳入文献差异性较大,故研究结果需谨慎对待,还需大样本、高质量的文献进一步证实其临床疗效。

Objective To evaluate the efficacy of auricular point therapy for insomnia,and to provide references for insomnia patients.Methods Such databases as the PubMed,Cochrane library,CBM,CNKI,VIP and WanFang Data were searched to collect randomized controlled trials（RCTs）on auricular point therapy for insomnia published before September 2014,and the references of the included literature were also retrieved.According to the inclusion and exclusion criteria,the data were further screened and the quality of the included papers were assessed.Then meta analysis was run using RevMan 5.0 software.Results A total of 7RCTs involving 939 patients were included.Subgroup analysis was processed based on the length of intervention and the intervention the control group received：① after 2-week intervention,the overall effective rate of the auricular point therapy group was higher than the control group（OR=10.66,95%CI ：5.23-21.74,P〈0.01）,and after 1-month intervention,the same effect was achieved（OR=4,54,95%CI：2.28-9.01,P〈0.01）;②the overall effective rate of the auricular point therapy group was higher than the acupuncture group（the controls）（OR=7.70,95%CI 3.05-19.48,P〈0.01）,and the medication group（OR=7.76,95%CI4.61-13.08,P〈0.01）.Conclusion On the basis of available evidence,the auricular point therapy has certain effect on insomnia and improves patients′sleep quality.However,there is too much heterogeneity among the included studies.Therefore,caution over the results of the meta analysis is urged.The clinical curative effect of the therapy requires large-sample and high quality studies to confirm.