针灸治疗原发性高血压病系统评价的再评价

Acupuncture therapy for essential hypertension:an overview of systematic reviews

目的汇总当前针灸治疗原发性高血压病的系统评价,评价其方法学偏倚及其证据体质量。方法计算机检索Pubmed、EMbase、The Cochrane library、CBM、CNKI及Wangfang Data等中英文数据库,检索针灸疗法治疗原发性高血压病的系统评价,检索时限从建库到2016年11月。采用系统评价方法学质量评估工具AMSTAR评价纳入的系统评价方法学质量,采用GRADE系统方法学评估纳入的系统评价主要结局指标的证据质量。结果共纳入14个系统评价,7篇是中文文献,7篇是英文文献。对原始研究方法学质量评估使用risk of bias工具的有9篇,使用改良Jadad量表的有4篇,1篇使用改良牛津量表。AMSTAR工具评价结果显示,影响系统评价方法学质量的11个条目中,条目1"是否提供了前期方案",条目3"是否进行了全面的文献检索",条目4"发表状态是否已考虑在纳入标准中"和条目10"是否评估了发表偏倚的可能性"存在的方法学偏倚最大。GRADE系统方法学对主要结局指标进行了证据质量评估,均为低级别或者极低级别。结论当前针灸治疗原发性高血压病有一定疗效,但其证据质量级别较低,临床实际中应用该证据时应当慎重。

Objective To evaluate the methodological and evidence quality of the conclusions of systematic review of acupuncture therapy for essential hypertension.Methods We searched the commonly used database such as Pubmed,EMbase,The Cochrane library,CBM,CNKI and Wangfang Data to collect systematic reviews of acupuncture therapy for essential hypertension from inception through Nov,2016.The AMSTAR tool was used for the assessment for the methodological quality of the included systematic reviews,while the GRADE system was applied for the evidence quality assessment of the primary outcomes included studies.Results 14 systematic reviews met the inclusion criteria,7 was published in Chinese and 7 was published in English.Among the included studies,risk of bias was applied in 9 studies for the assessment of methodological bias,while adopted Jadad tool was used in 4 studies.The results of AMSTAR tool showed that among the 11 domains,domain 1“was a prior design provided”,domain 3“Was a comprehensive literature search performed?”,domain 4“Was the status of publication(i.e.grey literature)used as an inclusion criterion?”and domain 10“Was the likelihood of publication bias assessed?”had the most problems.The result of the quality evidence showed that all the primary outcomes of the acupuncture therapy for essential hypertension were low or very low-quality evidence.Conclusion Currently,acupuncture therapy may have effect on essential hypertension,but the quality of evidence was low.So,clinical doctors should pay more attention on these evidence,everyone may take acupuncture therapy for essential hypertension with caution in clinical practice.