不同深度针刺天枢穴治疗功能性便秘的疗效比较:网状Meta分析

A Network Meta-analysis of Different Depth of Acupuncture for Functional Constipation Treatment

目的:采用网状Meta分析方法比较不同深度针刺天枢穴治疗功能性便秘的疗效。方法:应用计算机检索PubMed、The Cochrane Library(2018年2期)、中国知网、维普及万方数据库,收集有关不同深度针刺天枢穴治疗功能性便秘的临床研究。进行文献质量评价后,采用Stata13.0绘制网络图,用review manager5.3软件进行传统Meta分析,用Gemtc 14.3软件进行网状Meta分析。结果:共纳入15个研究,1 589例患者。Meta分析结果显示:①在增加周自主排便次数方面,深刺与常规针刺、浅刺及乳果糖相比,常规针刺与浅刺及乳果糖相比,浅刺与乳果糖相比,差异均具有统计学意义;②在降低CCS评分方面,深刺与常规针刺及乳果糖相比,浅刺与乳果糖相比,差异具有统计学意义;深刺与浅刺相比,常规针刺与浅刺及乳果糖相比,差异均无统计学意义。概率排序:增加周自主排便次数及降低CCS评分的疗效由高到低均依次为:深刺>浅刺>>乳果糖>常规针刺。结论:天枢穴深刺治疗功能性便秘疗效最佳,其次为浅刺,乳果糖第三,常规针刺疗效最差。由于深刺容易导致针刺部位疼痛、腹泻、全身酸痛,故考虑到病人的舒适度,浅刺可能为最佳的选择。由于本研究的局限性,上述结论需谨慎看待,需要开展更多高质量的直接比较研究来验证。

Objective:We made a network Meta-analysis to compare the different depth of acupuncture at Tianshu(ST25)in the treatment of functional constipation(FC).Methods:We searched the EMbase,PubMed,the Cochrane Library(Issue 2,2018),CNKI,VIP and Wangfang databases to find the clinical studies about ST25 for treating FC.After assessing the risk of bias,we used the Stata13.0 software to make network plot,and used Review manager 5.3 traditional Meta analysis,and then used Gemtc 14.3 software to make a network Meta analysis.Results:15 studies were included,1589 patients in total.The results showed that:(1)In the aspect of improving weekly spontaneous bowel movements(SBMs),there were significant difference when compared deep needling with standard needling,shallow needling and lactulose,compared tandard needling with shallow needling and lactulose,and compared shallow needling and lactulose;(2)In the aspect of decreasing CCS score,there were significant difference when compared deep needling with standard needling and lactulose,and compared shallow needling and lactulose,while there were not significant difference when compared deep needling with shallow needling and compared standard needling with shallow needling and lactulose.The probability ranking was deep needling >shallow needling > lactulose > standard needling.Conclusion:The therapeutic effect of treating FC of deep needling at ST25 was best,and that of shallow needling wad second,and that of lactulose was third and that of the standard needling was worse.The shallow needling may be the best choice for that the deep needling had more side effects.Because of the limitations in our study,the conclusion was needed to be verified by more direct comparing studies.