针刺联合拔罐治疗单纯性肥胖疗效性及安全性的Meta分析

Efficacy and Safety of Acupuncture Combined with Cupping in the Treatment of Simple Obesity:A Meta-Analysis

目的系统评价针刺联合拔罐治疗单纯性肥胖的疗效。方法计算机检索中文科技期刊全文数据库(CNKI)、万方数据库(WangFang Data)、维普数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed数据库,搜集针刺联合拔罐治疗单纯性肥胖的随机对照试验(randomized controlled trial,RCT),检索时间范围均从建库至2019年6月。选取2名研究者独立进行文献筛选、资料提取以及偏倚风险评价,使用RevMan5.3软件对纳入研究进行Meta分析。结果共纳入13项研究,共计1084例患者。Meta分析结果显示:在比较临床总有效率、体重、体重指数(Body Mass Index,BMI)、腰围方面根据对照组干预措施的不同进行亚组分析,所有疗程结束后,针刺联合拔罐治疗单纯性肥胖的临床总有效率优于针刺对照组(OR=2.28,95%CI[1.56,3.32])和拔罐对照组(OR=8.79,95%CI[4.20,18.40]);在改善单纯性肥胖患者体重方面,针刺联合拔罐较针刺对照组(Z=2.72,P=0.007,SMD=-0.21,95%CI[-0.36,-0.06])和拔罐对照组(Z=4.23,P<0.001,SMD=-0.54,95%CI[-0.79,-0.29])有一定优势;在改善单纯性肥胖患者BMI方面,针刺联合拔罐较针刺对照组(Z=8.70,P<0.00001,SMD=-0.69,95%CI[-0.85,-0.54])和拔罐对照组(Z=3.30,P=0.001,SMD=-0.42,95%CI[-0.67,-0.17])有一定优势;针刺联合拔罐较针刺对照组(Z=3.14,P=0.002,SMD=-0.46,95%CI[-0.75,-0.17])在改善单纯性肥胖患者腰围方面呈现一定优势,而针刺联合拔罐组与拔罐对照组(Z=1.39,P=0.17,SMD=-0.33,95%CI[-0.81,-0.14])在改善单纯性肥胖患者腰围方面的差异无统计学意义。在比较臀围及腰臀比方面,针罐联合组对比对照组在改善单纯性肥胖患者臀围方面的差异无统计学意义(Z=1.49,P=0.14,SMD=-0.22,95%CI[-0.52,0.07]),针罐联合组对比对照组在改善单纯性肥胖患者腰臀比方面的差异无统计学意义(Z=1.01,P=0.31,SMD=-0.11,95%CI[-0.32,0.10])。13个研究中有3个研究报告了不良反应,未见明显不良反应,安全性尚可。结论根据当前研究证据表明,针刺联合拔罐较单纯应用针刺或拔罐相比,在改善单纯性肥胖患者体重、BMI以及腰围方面优势较明显,且安全性尚可。本研究纳入RCT数量较少,方法学质量偏低,且存在一定的发表偏倚,需进一步高质量研究对上述结论进行验证。

Objective To systematically evaluate the efficacy of acupuncture combined with cupping for simple obesity.Methods Randomized controlled trials(RCT)of acupuncture combined with cupping for simple obesity were collected in CNKI,Wanfang Data,VIP,PubMed,and CBM databases.The search time ranged from the establishment of the database to June 2019.Two researchers were selected to conduct independent literature screening,data extraction,and risk assessment of bias.Meta-analysis was performed on the included studies using RevMan5.3 software.Results A total of 13 studies were including 1084 patients.The results of meta-analysis showed that subgroup analysis was performed according to the different interventions in the control group in terms of total clinical effective rate,body weight,Body Mass Index(BMI),and waist circumference.After all treatments,the total effective rate of acupuncture combined with cupping for simple obesity was better than acupuncture control group(OR=2.28,95%CI[1.56,3.32])and cupping control group(OR=8.79,95%CI[4.20,18.40]);Acupuncture combined with cupping in improving the body weight of patients with simple obesity was better compared with the acupuncture control group(Z=2.72,P=0.007,SMD=-0.21,95%CI[-0.36,-0.06])and the cupping control group(Z=4.23,P<0.001,SMD=-0.54,95%CI[-0.79,-0.29]);In improving BMI in patients with simple obesity,acupuncture combined with cupping is better than acupuncture control group(Z=8.70,P<0.00001,SMD=-0.69,95%CI[-0.85,-0.54])and cupping control group(Z=0.30,P=0.001,SMD=-0.42,95%CI[-0.67,-0.17]);Acupuncture combined with cupping compared with acupuncture control group(Z=3.14,P=0.002,SMD=-0.46,95%CI[-0.75,-0.17])showed advantages in improving the waist circumference of patients with simple obesity,while acupuncture combined with cupping group and cupping control group(Z=1.39,P=0.17,SMD=-0.33,95%CI[-0.81,-0.14])in improving simple obesity.There was no significant difference in terms of those waist.In terms of comparing hip circumference and waist-to-hip ratio.There was no significant difference in the hip circumference between the acupuncture group and the control group in improving the obesity(Z=1.49,P=0.14,SMD=-0.22,95%CI[-0.52,0.07]).There was no significant difference in the improvement of waist-to-hip ratio in patients with simple obesity compared with the control group(Z=1.01,P=0.31,SMD=-0.11,95%CI[-0.32,0.10]).Three of the 13 studies reported adverse reactions,no significant adverse reactions,and safety was acceptable.Conclusion According to current research evidence,acupuncture combined with cupping has obvious advantages in improving weight,BMI,and waist circumference of patients with simple obesity compared with simply using acupuncture or cupping,and the safety is acceptable.The number of RCTs included in this study is low,the methodological quality is low,and there is a certain publication bias.Further high-quality studies are needed to verify the above conclusions.