穴位埋线治疗慢性荨麻疹疗效与安全性的系统评价

Effectiveness and Safety of Acupoint Catgut-embedding for Treatment of Chronic Urticaria: A Systematic Review

【目的】系统评价穴位埋线治疗慢性荨麻疹的疗效与安全性。【方法】计算机全面检索Cochrane Library、PubMed、Embase、万方(Wanfang)、维普(VIP)、中国学术期刊全文数据库(CNKI)和中国生物医学文献数据库(CBM),检索时限均从建库至2017年8月,查找穴位埋线治疗慢性荨麻疹的随机对照试验(RCTs)。由2名研究者独立进行筛选、数据提取和质量评价后,采用RevMan 5.2软件对数据进行统计学分析。【结果】纳入的12个RCTs,共836例慢性荨麻疹患者。Meta分析结果显示:穴位埋线治疗慢性荨麻疹的有效率优于其他疗法[RR=1.10,95%CI(1.03,1.16),P=0.002];穴位埋线治疗慢性荨麻疹的治愈率优于其他疗法[RR=1.59,95%CI(1.30,1.95),P<0.000 05];穴位埋线组的复发率低于常规治疗组[RR=0.49,95%CI(0.27,0.86),P=0.01];描述性分析显示穴位埋线组较常规疗法组有更少的不良反应。【结论】与常规抗组胺药和常规针灸及中药相比,穴位埋线有更好的治愈率和有效率,且对降低复发率起到一定的作用。但由于纳入的研究存在较大的偏倚风险,证据强度较低,当前的证据尚不能完全用于临床,其疗效优势和安全性仍需要通过开展更多高质量多中心大样本随机对照试验来验证。

Objective To systematically evaluate the effectiveness and safety of acupoint catgut-embedding for the treatment of chronic urticaria(CU). Methods We searched the Cochrane Library,PubMed,Embase,Wanfang data library,VIP Database,China National Knowledge Infrastructure(CNKI)and China Biology Medicine disc(CBM)to collect the randomized controlled trials(RCTs)of acupoint catgut-embedding for the treatment of CU from data beginning to August 2017. According to the inclusion and exclusion criteria,the literature screening,data extraction,and quality assessment were performed by 2 researchers independently,the data were statistically analyzed by RevMan 5.2. Results A total of 12 RCTs involving 836 patients were enrolled. The results of Meta-analysis showed that the effective rate of acupoint catgut-embedding in treating CU was superior to that of other therapies [RR=1.10, 95% CI(1.03, 1.16), P = 0.002], and the cure rate of acupoint catgut-embedding in treating CU was superior to that of other therapies [RR=1.59, 95% CI(1.30, 1.95), P<0.000 05]. The recurrence rate of acupoint catgut-embedding group was lower than that of the conventional therapy group [RR =0.49, 95% CI(0.27, 0.86), P = 0.01]. The descriptive analysis results showed that the acupoint catgut-embedding group had fewer adverse effects than the conventional therapy group. Conclusion Compared with the conventional antihistamines,routine acupuncture and traditional Chinese medicine,acupoint catgut-embedding has better cure rate and clinical efficiency in the treatment of CU, and plays a certain role in reducing the recurrence rate. However,due to the high risk of bias in the included studies,the evidence reliability is relatively low,and the current evidence cannot be fully used in clinical practice,so its efficacy advantage and safety still need to be verified by more high-quality multi-center large-scale RCTs.