耳穴贴压治疗成人单纯性肥胖效果的Meta分析

Effect of Auricular Pressure Therapy for Simple Obesity in Adult: A Meta-analysis

目的系统评价耳穴贴压治疗单纯性肥胖症的疗效。方法计算机检索The Cochrane Library(2015年第4期)、PubMed、Web of Science、MEDLINE(Ovid)、VIP、CNKI、CBM和WanFang Data数据库,搜集耳穴贴压治疗单纯性肥胖的相关随机对照试验(RCT),检索时限均从建库至2015年3月。由2名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入17个RCT,包括1 246例患者。Meta分析结果显示:1与空白对照组相比,耳穴贴压组在减轻体重[MD=–2.50,95%CI(–3.53,–1.47),P<0.01]、改善BMI[MD=–1.50,95%CI(–2.52,–0.48),P=0.004]和腰围[MD=–3.20,95%CI(–4.38,–2.02),P<0.01]方面效果更好;2与安慰剂对照组相比,耳穴贴压组在减轻体重[MD=–1.39,95%CI(–1.46,–1.31),P<0.000 01]、改善BMI[MD=–0.61,95%CI(–0.94,–0.28),P=0.000 2]、体脂百分比[MD=–0.58,95%CI(–0.67,–0.49),P<0.000 01]和腰围[MD=–2.88,95%CI(–5.04,–0.73),P=0.009]方面效果更好;3与体针治疗组相比,耳穴贴压组在减轻体重、改善BMI和腰围方面差异均无统计学意义(P均>0.05);4与体针治疗组相比,耳穴贴压联合体针治疗组在改善BMI方面效果更好[MD=–1.67,95%CI(–2.48,–0.85),P<0.000 1];5 3个研究报告出现耳压处皮肤青紫、红斑等不良反应,及时处理后愈合较好,未见其他不良反应报道。结论当前证据显示,对于单纯性肥胖的治疗,耳穴贴压的疗效优于空白对照或安慰剂对照,与体针相当;耳穴贴压联合体针治疗对改善BMI优于单纯体针治疗。受纳入研究的数量和质量的限制,本研究结论尚需开展更多高质量研究予以证实。

Objective To systematically review the efficacy of auricular pressure therapy for simple obesity in adult. Methods We electronically searched databases including The Cochrane Library（Issue 4, 2015）, PubMed, Web of Science, MEDIINE（Ovid）, CNKI, VIP, CBM and WanFang Data databases to collect randomized controlled trials（RCTs）of auricular pressure therapy for simple obesity from inception to March 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 17 RCTs involving 1 246 patients were included. The results of meta-analysis showed that：（1） Compared with the blank control group, the auricular pressure therapy group was superior in weight reduction（MD= –2.50, 95%CI –3.53 to –1.47, P〈0.01）, BMI reduction（MD= –1.50, 95%CI –2.52 to –0.48, P=0.004）, and waist circumference reduction（MD= –3.20, 95%CI –4.38 to –2.02, P〈0.01）;（2） Compared with the placebo control group,the auricular pressure therapy group was superior in weight reduction（MD= –1.39, 95%CI –1.46 to –1.31, P〈0.01）, BMI reduction（MD= –0.65, 95%CI –0.91 to –0.38, P〈0.01）, body fat percentage reduction（MD= –0.58, 95%CI –0.67 to –0.49,P〈0.01）, and waist circumference reduction（MD= –2.34, 95%CI –4.23 to –0.46, P=0.01）;（3） There were no significant differences between the auricular pressure therapy group and the body acupuncture group in weight reduction, BMI reduction, and waist circumference reduction（all P values 0.05）;（4） Compared with the body acupuncture group, the auricular pressure combined with body acupuncture group was superior in BMI reduction（MD= –1.67, 95%CI –2.48 to–0.85, P〈0.01）;（5） Three RCTs reported adverse reactions including cyanotic skin, erythema near auricular pressure etc., and all adverse reactions were mostly mild and recovered after treatment. Conclusion Current evidence indicates that auricular pressure therapy for simple obesity is superior to placebo and blank control, but similar to body acupuncture; the auricular pressure combined with body acupuncture is superior to body acupuncture alone in BMI reduction. Due to the limited quantity and quality of included studies, more high quality studies are needed to verify the above conclusion.