针刺调神法治疗腹泻型肠易激综合征的Meta分析

A Meta-Analysis on the Method of Acupuncture Spirit-Regulation for Treating Irritable Bowel Syndrome with Diarrhea

目的:运用Meta分析评价针刺调神法治疗腹泻型肠易激综合征(IBS-D)的疗效。方法:计算机检索各类数据库中关于针刺调神治疗IBS-D的临床随机对照试验文献;纳入研究符合罗马III诊断标准;文献质量运用Revman5.3软件中Cochrane手册风险偏倚工具评估,纳入研究的数据应用RevMan 5.3软件分析;以上均由2名评价员独立完成。结果:1)纳入10篇研究,总察病例533例,针刺调神组284例,其他方法组249例。2)Meta分析结果显示:针刺调神法治疗IBS-D临床疗效优于其他治疗方法,P<0.00001,差异有统计学意义(OR=4.09,95%CI:2.41-6.93);针刺调神组IBS-SSS评分优于西药组,差异有统计学意义;针刺调神法与其他方法在改善HAMD方面由于异质性过大、样本量小,未体现出明显差异性;3)纳入研究漏斗图提示可能有潜在的发表偏倚。4)纳入研究未明确报道随访。结论:1)针刺调神法治疗IBS-D的有效性优于西药与常规针刺,可明显改善IBS-SSS评分,改善临床症状;该法具有改善焦虑、抑郁等情志问题的潜质,应进行大样本、高质量临床对照研究,以进一步提高的循证医学证据。2)应拓宽调神法的运用思路,“脑肠同治”,丰富针刺调神法治疗IBS-D的方案。

Objective:Meta-analysis was applied to evaluate the effectiveness of acupuncture method of spirit-regulation in the treatment of irritable bowel syndrome with diarrhea(IBS-D).Methods:Various databases about clinical randomized controlled trials(RCT)of acupuncture method of spirit-regulation in the treatment of IBS-D was retrieved by computer;the included study met the Rome III diagnostic criteria;literature quality was assessed by the Cochrane risk bias tool in Revman5.3 software,and the data included in the study were analyzed by RevMan 5.3 software;all the above were completed by 2 evaluators independently.Results:1)A total of 10 literature were included,with 533 total cases.Among them,284 were in acupuncture method of spirit-regulation group and 249 patients were in the other groups.2)Results of Meta analysis showed that:the clinical efficacy of the acupuncture method of spirit-regulation group was better than that of the other group,and difference was statistically significant,P<0.00001(OR=4.09,95%CI:2.41-6.93);IBS-SSS score of acupuncture method of spirit-regulation group were better than that of the Western medicine group,and difference was statistically significant.Acupuncture method of spirit-regulation and other methods did not show obvious differences in improving HAMD due to excessive heterogeneity and small sample size.3)The inclusion of symmetrical funnel plots suggests that the risk of potential publication bias was small.Conclusion:1)Acupuncture method of spirit-regulation is more effective in treating IBS-D than Western medicine and conventional acupuncture and can significantly improve IBS-SSS score and clinical symptoms.This method has the potential to improve emotional problems such as anxiety and depression,and a large sample of high-quality controlled clinical studies should be conducted to further improve the evidence of evidence-based medicine.2)It is necessary to broaden the application idea of spirit-regulating method,adopt“brain-gut treatment”and enrich the program of spirit-regulating method of acupuncture for the treatment of IBS-D.