针灸对比西药治疗黄褐斑的Meta分析

The Treatment of Melasma by Acupuncture Compared to Western Medicine :A Systematic Review and Meta-analysis

目的:系统评价针灸治疗黄褐斑的疗效与安全性。方法:计算机检索CNKI、维普数据库、万方数据库、CBM、Pubmed,收集针灸对比西药治疗黄褐斑的随机临床对照试验。检索时限为建库至2016年10月。由两名研究者按照文献的纳入与排除标准独立筛选文献、评价质量、提取数据、交叉核对。采用Revman5.2软件进行Meta分析,漏斗图分析发表偏倚。结果:最终纳入25篇RCT共2 726例患者。Meta分析结果显示:两组的总有效率比较:RR=1.32,95%CI=1.261.39,P<0.01;皮损评分下降指数比较WMD=0.20,95%CI=0.110.28,P<0.01;两组均无严重不良反应,Meta分析结果无统计学意义(P=0.58>0.05),针灸组的不良反应由穴位敷贴引起。目测漏斗图对称,提示不存在明显的发表偏倚。结论:基于目前数据,针灸治疗黄褐斑在总有效率以及改善皮损积分方面均优于西药治疗;在不良反应方面,针灸治疗与西药治疗无显著性差异。但受纳入研究的质量限制,上述结果需要更多高质量、大样本的RCT进一步证实。

Objective To evaluate systematically the efficacy and safety of acupuncture in the treatment of melasma compared with western medicine. Methods The databases of CBM,Pubmed, CNKI,VIP, Wanfang Database were retrieved for collecting the randomized controlled trials （RCT） about the treatment of melasma by acupuncture compared with western medicine from database establishment time to Oct.2016.Data were exracted,evaluated and cross checked by two reviewers independently according to inclusion and exclusion criteria.Cochrane Collaboration＇s RevMan 5.2 software was used for data analysis.Funnel plot was used for possible exsistence of publication bias. Results A total of 25 RCTs involving 2726 patients were included. Meta-analysis showed that：the comparision of the total effective rate of the two groups is RR=l.32,95%CI=l.261.39,P〈0.01;the comparision of skin lesion score decreased index of the two groups is WMD=0.20,95%CI=0.110.28,P〈0.01. There were no serious side effects in both groups.Result of Meta-analysis showed no statistical significance（P=0.58〉0.05）.The side effects in acupuncture group were caused by acupoint application.Funnel plot is symmetrical which showed that there is no possible exsistence of publication bias. Conclusion Based on present evidence,in the treatment of melasma,acupuncture is better than western medicine in the total efficiency and improvement of skin lesions. In the adverse reactions, acupuncture and western medicine treatment has no significant difference.As the quality of included analyses is limited, more large-sample RCT with higher quality are required for further identifying the results.