放血疗法治疗急性扁桃体炎的Meta分析

Meta-Analysis of Bloodletting Therapy for Acute Tonsillitis

目的:系统评价放血疗法治疗急性扁桃体炎的有效性。方法:系统检索CNKI、CBM、VIP、万方、PubMed、Embase、Cochrane Library数据库中有关放血疗法治疗急性扁桃体炎的文献,检索时限均设定为从建库至2019年12月5日,由2名研究者按照拟定标准独立进行原始文献筛选、资料提取,并采用Cochrane偏倚评估手册对符合纳入标准的文献进行质量评价,采用RveMan5.2软件进行数据分析,采用Excel软件导出穴位频数分布图并分析选穴规律。结果:共纳入18个随机对照试验,共计1306个患者。Meta分析结果显示:(1)在临床有效率[OR=5.51,95%CI(3.65,8.31),P<0.000,01]、退热时间[WMD=-1.00,95%CI(-1.40,-0.60),P<0.000,01]、咽痛缓解时间[WMD=-1.68,95%CI(-2.39,-0.96),P<0.000,01]、提高免疫功能、复发情况及不良反应方面,试验组均优于对照组;(2)治疗后的白细胞总数(WBC)[WMD=0.40,95%CI(-0.72,1.52),P=0.49]和C反应蛋白(CRP)方面[WMD=-2.20,95%CI(-5.90,1.50),P=0.24]比较,试验组与对照组无明显差异;(3)穴位使用频数排名前3的分别是少商、商阳和耳尖。结论:放血疗法治疗急性扁桃体炎在临床有效率、退热时间、咽痛缓解时间、提高免疫功能、复发情况及不良反应方面均优于常规抗生素治疗,但由于纳入的临床研究普遍质量不高,故仍需更多大样本、高质量、严格方法学设计和质量控制的临床随机对照试验的实施,以期能够为验证放血疗法治疗急性扁桃体炎的临床有效性提供更可靠的证据。

Objective:To systematically evaluate the effectiveness of bloodletting therapy in the treatment of acute tonsillitis.Methods:The literatures on bloodletting therapy for acute tonsillitis were systematically searched from databases of CNKI,CBM,VIP,WF,PubMed,Embase and Cochrane Library.The search time limit was set from the establishment of the database to December 5,2019.And two authors independently screened literature,extracted data,and used the Cochrane bias evaluation manual to evaluate the quality of the documents that met the inclusion criteria.ReverMan5.2 software was used for data analysis.Excel software was used to export acupoint frequency distribution figure and analyze the law of selecting acupuncture Points.Results:A total of 18 randomized controlled trials were included,a total of 1306 cases involved.According to the meta-analysis results,firstly,the treatment group was superior to the control group in clinical efficiency[OR=5.51,95%CI(3.65,8.31),P<0.0000,1],antipyretic time[WMD=-1.00,95%CI(-1.40,-0.6),P<0.000,01],sore throat relief time[WMD=-1.68,95%CI(-2.39,-0.96),P<0.000,01],improvement of immune function,recurrence and adverse reactions;Secondly,there was no significant difference between the treatment group and the control group in terms of the total number of WBC[WMD=0.40,95%CI(-0.72,1.52),P=0.49]and CRP[WMD=-2.20,95%CI(-5.90,1.50),P=0.24]after treatment;Thirdly,the top three in the frequency of use of acupoints are Shaoshang(LU11),Shangyang(LI1)and Erjiang(EX-HN6).Conclusion:Bloodletting therapy is superior to conventional antibiotics in the treatment of acute tonsillitis in terms of clinical efficiency,antipyretic time,sore throat relief time,improvement of immune function,recurrence and adverse reactions.However,the clinical quality of the included clinical studies is not high,and more large-scale,high-quality,rigorous methodological design and quality control clinical randomized controlled trials are needed to provide more reliable evidence for validating the clinical effectiveness of bloodletting therapy for acute tonsillitis.