夹脊穴注射糖皮质激素预防50岁以上带状疱疹后神经痛的meta分析

Efficacy and Safety of Injection in Jiaji Acupoints with Corticosteroids for Preventing Post Herpetic Neuralgia in Adults Aged More Than 50 Years:A Meta-analysis

目的评价夹脊穴注射糖皮质激素对预防50岁以上患者带状疱疹后遗神经痛的疗效及安全性。方法计算机检索Cochrane Library、Pub Med、EMbase、CNKI、CBM、Wan Fang和VIP(从建库至2015年10月),纳入夹脊穴注射糖皮质激素或椎旁神经阻滞与空白或安慰剂对照治疗急性带状疱疹的随机对照试验,治疗组与对照组可结合或不结合基础治疗。由2名研究者按照Cochrane Handbook标准独立评价文献质量、提取数据并交叉核对,使用Rev Man5.3软件进行Meta分析。结果共纳入4个研究,合计1 374例患者。Meta分析结果显示:6个月时PHN的发生率试验组低于对照组[RR=0.39,95%CI(0.16,0.94)];除对照组出现1例严重不良反应外,其余均未报道严重不良反应。结论基于目前的证据,夹脊穴注射糖皮质激素可能预防或降低50岁以上患者PHN的发生率,且安全较好,但尚缺乏更多高质量的研究,目前还不能得到更为可靠的结论。

Objective In order to assess the efficacy and safety of injection in Jiaji acupoints with corticosteroids for preventing post herpetic neuralgia（PHN） in adults aged more than 50 years. Methods Cochrane Library, Pub Med, EMbase,CNKI, CBM, Wan Fang and VIP were searched by computer（the inception to October 2015）. All randomized clinical trials（RCT）of treating acute herpes zoster with corticosteroids given by injection in Jiaji acupoints or paravertebral blockade versus those using corticosteroids with non-blockade treatment or placebo（sham blockade）, both groups were separately to be with or without basic treatment, were included. Data were extracted independently by two reviewers. The methodological quality of trials was evaluated with Cochrane Handbook 5.0.2 criteria. Meta-analyses were performed by the Rev Man 5.0 software. Results Four trials involving 1 374 patients were included. The Meta-analysis results showed that the incidence of PHN after rash onset in experimental group was lower than that in control group. No major adverse events were reported except for 1 case in the control group. Conclusion Based on the current evidence, injection in Jiaji acupoints with corticosteroids may be effective and safe in preventing or reducing PHN in adults aged more than 50 years, which cannot be strongly proved at present for lack of more studies with high quality.