针刺改善偏头痛症状和脑血流速度的Meta分析

Efficacy of acupuncture for improving migraine symptoms and cerebral blood flow velocity: a meta-analysis

目的系统评价针刺改善偏头痛症状和脑血流速度的疗效。方法计算机检索PubMed、EMbase、The Cochrane Library、CNKI、WanFang Data、CBM和VIP数据库,搜集针刺改善偏头痛症状和脑血流速度的随机对照试验(RCT),检索时限均从建库至2017年9月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入17个RCT,包括2 226例患者。Meta分析结果显示:针刺组与假针刺[SMD=-0.97,95%CI(-1.60,-0.34),P=0.002]及药物组[SMD=-1.29,95%CI(-1.85,-0.73),P<0.000 01]相比,能明显减少头痛发作频率;针刺组与假针刺组[SMD=-0.73,95%CI(-1.25,-0.21),P=0.006]及药物组[SMD=-0.88,95%CI(-1.32,-0.45),P<0.000 1]相比,能减少头痛持续时间;针刺组较假针刺组能够减轻头痛强度[SMD=-0.67,95%CI(-1.15,-0.19),P=0.006],且在改善脑血流速度方面优于假针刺组[SMD=-10.99,95%CI(-16.62,-5.36),P=0.000 1]及药物组[SMD=-0.63,95%CI(-0.87,-0.40),P<0.000 01]。结论当前研究证据表明,针刺可减少偏头痛发作频率、减少头痛持续时间、减轻头痛强度同时改善脑血流速度。受纳入研究质量限制,该结论有待更多高质量研究进行验证。

Objectives To systematically review the efficacy of acupuncture for improving migraine symptoms and cerebral blood flow velocity. Methods CBM, CNKI, VIP, WanFang Data, PubMed, EMbase and The Cochrane Library databases were electronically searched to collect randomized controlled trials(RCTs) on acupuncture for improving migraine symptoms and cerebral blood flow velocity from inception to September, 2017. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 17 RCTs involving 2 226 patients were included. The results of meta-analysis showed that, acupuncture could effectively reduce the frequency of migraine compared with placebo acupuncture(SMD=-0.97, 95%CI-1.60 to-0.34, P=0.002) and medicine group(SMD=-1.29, 95%CI-1.85 to-0.73,P<0.000 01). Acupuncture could shorten duration of headache compared with placebo acupuncture(SMD=-0.73, 95%CI-1.25 to-0.21, P=0.006) and medicine group(SMD=-0.88, 95%CI-1.32 to-0.45, P<0.000 1). Compared with placebo acupuncture, acupuncture could relieve headache intensity(SMD=-0.67, 95%CI-1.15 to-0.19, P=0.006). The acupuncture group was superior to the placebo acupuncture group(SMD=-10.99, 95%CI-16.62 to-5.36, P=0.000 1) and medicine group(SMD=-0.63, 95%CI-0.87 to-0.40, P<0.000 01) in improving the cerebral blood flow velocity.Conclusions Current evidence shows that acupuncture can effectively reduce frequency of migraine, shorten duration of migraine, relieve intensity of migraine and improve cerebral blood flow velocity. Due to limited quality of the included studies, more high quality studies are required to verify above conclusion.