浮针治疗网球肘有效性的系统评价及Meta分析

Systematic Evaluation and Meta-analysis of Effectiveness of Fu’s Subcutaneous Needling in Treatment of Tennis Elbow

目的：客观评价浮针治疗网球肘的有效性。方法：通过检测Pub Med、Google Scholar、Cochrane Library、CBM、CNKI、VIP、万方数资源据库,收纳浮针治疗网球肘的随机对照试验研究资料,运用GRADE profile 3.6对文献进行证据等级评价,应用Revman 5.3以及STATA 12.0软件对其总有效率效应结局指标进行分析。结果：最终17篇文献符合纳入标准,合计病例1251例。文献证据等级评价：GRADE分级结果提示等级极低。异质性评价：异质性数值检验（χ2=14.73,P=0.54,I2=0%〈50%）确定为无异质性或小。偏倚评估：应用Egger检验法分析潜在的发表偏倚,P=0.006〈0.05,其95%CI[0.611,3.013],提示存在发表偏倚。Meta分析结果：浮针或联合其他疗法对网球肘临床总疗效优于其他疗法,有效率差异具有统计学意义[OR=4.99,95%CI（3.13,7.95）,Z=8.10,P〈0.000 01]。浮针分别与对照组不同干预措施比较：进一步得出浮针临床疗效分别优于常规针刺、电针、局部封闭。浮针对照火针,OR=7.50,95%CI（0.78,72.44）,Z=1.74,P=0.08〉0.05,有效率差异无统计学意义。结论：浮针治疗网球肘具有相对优势,可在临床上进行推广。囿于文献质量偏低,尚需要更多多中心、大样本量、高质量的随机对照研究对上述结果进行进一步验证。

Objective： To evaluate the effectiveness of Fu＇s subcutaneous needling or tennis elbow. Methods： By detecting Pub Med,Google Scholar,the Cochrane Library,CBM,CNKI,VIP,Wanfang Data,Fu＇s subcutaneous Needling treatment of tennis elbow randomized controlled trials were collected. By using the GRADE profile 3. 6 we judged the level of evidence of literature and using Revman 5. 3 and STATA 12. 0 software we analyzed its total effective effect outcome indicators. Results： In the end,17 pieces of literature met the inclusion criteria and a total of 1251 cases were recorded.The GRADE rating of GRADE was very low. Heterogeneity evaluation： heterogeneity value test（ χ2= 14. 73,P = 0. 54,I2= 0% 〈50%） was determined to be non-heterogeneity or small. Bias assessment： analysis of potential publication bias by using the Egger test method,P = 0. 006〈 0. 05,95% CI[0. 611,3. 013],indicating the existence of publication bias. The results of Meta-analysis： the total therapeutic effect of Fu＇s subcutaneous needling or combination therapy was superior to that of other treatments,and the effective difference was statistically significant[OR = 4. 99,95% CI（ 3. 13,7. 95）,Z = 8. 10,P〈 0. 000 01]. The Fu＇s subcutaneous needling was reported to the control group,and the clinical effect of the Fu＇s subcutaneous needling was better than that of conventional acupuncture,electro acupuncture and local block. The efficiency difference was not statistically significant. The effect was not statistically significant,but the efficiency difference was not statistically significant. Conclusion： The treatment of tennis elbow with Fu＇s subcutaneous needling has a comparative advantage and can be popularized clinically. Due to the low literature quality,more central,large sample size and high quality randomized controlled studies are needed to further verify the results.