针刺治疗过敏性鼻炎系统评价和meta分析（英文）

Acupuncture for allergic rhinitis: a systematic review and meta analysis

目的:分析评价单纯针刺(包含单纯电针)对过敏性鼻炎(AR)的临床疗效,并与抗组胺药物治疗以及中成药鼻炎康片治疗进行对照观察。方法:按照循证医学的要求,制定原始文献的检索策略、纳入标准及排除标准,检索中国知网(CNKI)、万方学术期刊全文数据库(Wanfang)、重庆维普数据库(CQVIP)、中国生物医学文献数据库(CBM)、Pub Med、荷兰医学文摘(EMBASE)、科学网、Cochrane图书馆和Cochrane随机对照试验注册中心中1990年1月至2015年12月间针刺治疗AR的随机对照(RCTs)临床研究文献,以Cochrane系统评价手册5.1进行质量评价,采用Rev Man 5.3对纳入文献进行meta分析。结果:共20篇文献符合纳入标准。meta分析显示,针刺与抗组胺药物比较,合并RR=1.24>1,95%CI[1.15,1.33],P<0.00001,提示针刺治疗AR临床总有效率优于抗组胺药物;合并MD=–0.93<0,95%CI[–1.22,–0.63],P<0.00001,提示针刺降低AR患者鼻部症状评分的效果优于抗组胺药物;合并MD=1.46>0,95%CI[–10.84,13.75],P=0.82,提示针刺对AR患者血清免疫球蛋白E(Ig E)的影响与抗组胺药物无统计学差异。针刺与中成药鼻炎康片比较,合并RR=1.50>1,95%CI[1.30,1.73],P<0.00001,提示针刺治疗AR临床总有效率优于口服鼻炎康片。结论:单纯针刺治疗AR临床总有效率优于抗组胺药物治疗和中成药鼻炎康治疗,同时对于改善AR患者临床症状评分也优于抗组胺药物治疗,但从现有数据无法得知是否优于中成药鼻炎康片。在改善血清Ig E方面,目前数据显示,单纯针刺效果与抗组胺药物治疗无统计学差异,有待进一步研究。在所纳入的随机对照临床文献中,随机方法不详,盲法实施缺失,造成一定的偏倚风险,因此降低了整体结论的证据级别。

Objective： To analyze and review the clinical efficacy of acupuncture（including electroacupuncture） alone for allergic rhinitis（AR） and to compare its efficacy with antihistamines and Chinese patent medicine Bi Yan Kang Tablet. Methods： The search strategy, inclusion and exclusion criteria were made according to the principle of evidence-based medicine. We performed a systematic search on China National Knowledge Infrastructure（CNKI）, Wanfang Academic Journal Full-text Database（Wanfang）, Chongqing VIP Database（CQVIP）, Chinese Biomedical Literature Database（CBM）, Pub Med, Excerpta Medica Database（EMBASE）, Web of Science, Cochrane Library, and Cochrane Central Register of Controlled Trials（CENTRAL） for randomized controlled trials（RCTs） of acupuncture for allergic rhinitis between January 1990 and December 2015. The quality was evaluated by Cochrane Handbook for Systematic Reviews of Interventions Version 5.1, and the meta-analysis was conducted by Rev Man 5.3 version. Results： Twenty eligible RCTs were included into the meta-analysis after selection. Compared with antihistamines, the meta-analysis showed RR=1.241, 95%CI[1.15, 1.33], P〈0.00001, indicating that acupuncture achieved a better total effective rate for AR than antihistamines; MD=–0.93〈0, 95%CI[–1.22, –0.63], P〈0.00001, indicating that acupuncture is better than antihistamines in decreasing the total nasal symptom score（TNSS） in AR patients; and MD=1.46〉0, 95%CI[–10.84, 13.75], P=0.82, indicating that there was no statistical difference between acupuncture and antihistamines in regulating immunoglobulin E（Ig E） in AR patients. Compared with Bi Yan Kang Tablet, the meta-analysis has shown RR=1.50〉1, 95%CI[1.30, 1.73], P〈0.00001, indicating that acupuncture achieved a better total effective rate for AR than Chinese patent medicine Bi Yan Kang Tablet. Conclusion： Acupuncture alone can achieve a better total effective rate for AR than antihistamines and Bi Yan Kang Tablet. It is also better than antihistamines in improving clinical symptom scores; however, whether acupuncture is better than Bi Yan Kang Tablet needs further proof. As far as current data are concerned, there was no statistical difference between acupuncture and antihistamines in improving serum Ig E; further study is needed in this regard. The risk of bias due to absent randomization methods or blinding implementation decreased the evidence level of the overall conclusion.