针灸治疗慢性萎缩性胃炎的Meta分析

Therapeutic Effect of Acupuncture and Moxibustion on Chronic Atrophic Gastritis:A Meta-analysis

目的系统评价针灸治疗慢性萎缩性胃炎(CAG)的临床疗效。方法计算机检索PubMed、the Cochrane Library、Embase、Web of science、中国知网、万方、维普、中国生物医学文献数据库,检索时限为2009年1月1日至2019年10月30日,查找有关针灸治疗CAG的随机对照试验,根据纳入和排除标准筛选符合标准的文献,对其进行数据提取、质量评价和统计分析。结果共纳入文献13篇,总计1009例患者。Meta分析结果显示,针药结合、穴位埋线及穴位埋线联合药物治疗CAG总有效率均高于对照组(RR=5.20,95%CI 2.89~9.33,P<0.00001;RR=6.00,95%CI 1.41~25.43,P=0.02;RR=4.69,95%CI 1.76~12.47,P=0.002);单纯针刺及灸法与对照组总有效率比较差异无统计学意义(RR=2.74,95%CI 0.75~10.06,P=0.13;RR=3.60,95%CI 0.67~19.43,P=0.14)。单纯针刺、灸法及穴位埋线联合药物治疗CAG中医证候评分均低于对照组(MD=-2.30,95%CI-3.72^-0.88,P=0.002;MD=-2.08,95%CI-2.72^-1.44,P<0.00001;MD=-2.23,95%CI--4.37^-0.09,P=0.04);针刺和穴位埋线治疗CAG的病理组织评分均低于对照组(MD=-3.20,95%CI-5.33^-1.07,P=0.003;MD=-3.64,95%CI-5.81^-1.47,P=0.001)。穴位埋线治疗CAG胃镜下黏膜评分低于对照组(MD=-0.44,95%CI-0.55^-0.32,P<0.00001)。针药结合、温针炙及灸法与对照组幽门螺杆菌(Hp)转阴率比较差异无统计学意义(RR=1.46,95%CI 0.80~2.67,P=0.22;RR=1.71,95%CI 1.44~2.63,P=0.05;RR=1.20,95%CI 1.00~1.44,P=0.05)。结论针灸治疗CAG在临床疗效、中医证候、胃黏膜评分、病理组织评分及Hp转阴率方面均优于药物治疗。但由于本研究评价纳入文献存在高风险的选择性、实施性及测量性偏倚,纳入文献方法学质量评估不高,故今后的临床研究仍需进行更加严格、高质量的随机双盲对照试验,以期对未来针灸临床提供更可靠的证据。

Objective To evaluate the clinical effect of acupuncture and moxibustion on chronic atrophic gastritis( CAG). Methods The Chinese and English databases including Pub Med,the Cochrane Library,Embase,Web of science,CNKI,Wanfang,VIP,CBMdisc were searched to find randomized controlled trials of acupuncture and moxibustion treatment of CAG,and the documents that met the criteria were included according to the exclusion and inclusion criteria,to extract the data,assess the quality and perform the statistical analysis. Results A total of 13 articles involving 1 009 patients were included. Meta-analysis showed that the total effective rate of acupuncture combined with medicine,acupoint catgut embedding and acupoint catgut embedding combined with medicine was higher than that of the control group( RR = 5. 20,95% CI 2. 89-9. 33,P < 0. 000 01;RR = 6. 00,95% CI 1. 41-25. 43,P = 0. 02;RR = 4. 69,95% CI 1. 76-12. 47,P = 0. 002);there was no significant difference in total effective rate between acupuncture and moxibustion alone and control group( RR =2. 74,95% CI 0. 75-10. 06,P = 0. 13;RR = 3. 60,95% CI 0. 67-19. 43,P = 0. 14). The traditional Chinese medicine syndrome scores of simple acupuncture,moxibustion and acupoint catgut embedding combined with drugs in CAG group were lower than those of the control group( MD =-2. 30,95% CI-3. 72--0. 88,P = 0. 002;MD =-2. 08,95% CI-2. 72--1. 44,P < 0. 000 01;MD =-2. 23,95% CI--4. 37--0. 09,P = 0. 04). The pathological scores of CAG treated by acupuncture and acupoint catgut embedding were lower than those of the control group( MD =-3. 20,95% CI-5. 33--1. 07,P = 0. 003;MD =-3. 64,95% CI-5. 81--1. 47,P = 0. 001). The score of acupoint catgut embedding in CAG gastroscopy was lower than that in the control group( MD =-0. 44,95% CI-0. 55--0. 32,P < 0. 000 01). There was no significant difference in the negative conversion rate of Helicobacter pylori( Hp) between acupuncture combined with drug and warm acupuncture and moxibustion trial and the control group( RR = 1. 46,95% CI 0. 80-2. 67,P = 0. 22;RR = 1. 71,95% CI1. 44-2. 63,P = 0. 05;RR = 1. 20,95% CI 1. 00-1. 44,P = 0. 05). Conclusion Acupuncture and moxibustion treatment for CAG than the drug treatment in terms of clinical efficacy,traditional Chinese medicine syndromes,gastric mucosal integral,pathological histological integral and Hp conversion rate. However,due to the high risk of selectivity,implementation and measurement bias of the included literatures,the methodology quality evaluation of the included literatures is not high,the future clinical research still needs to carry out more rigorous and high-quality randomized double-blind controlled trials in order to provide more reliable evidence for the future acupuncture clinical practice.