热敏灸治疗带状疱疹后神经痛疗效与安全性的系统评价和Meta分析

Systematic Evaluation and Meta-analysis on the Therapeutic Effect and Safety of Heat-Sensitive Moxibustion in the Treatment of Postherpetic Neuralgia

目的系统评价热敏灸治疗带状疱疹后神经痛(PHN)的疗效与安全性。方法系统检索2020年5月10日前发表的热敏灸治疗PHN的随机对照试验(RCT)。结局指标为总有效率、视觉疼痛模拟评分(VAS)、皮损程度、睡眠质量、白介素-6(IL-6)和不良反应。结果共纳入15篇RCT(n=1032)。Meta分析显示:热敏灸组总有效率(OR 5.81,95%CI 3.69~9.14,P<0.00001)和睡眠质量(MD-1.18,95%CI-1.50~-0.85,P<0.00001)显著提高,VAS疼痛评分(MD-1.87,95%CI-2.39~-1.34,P<0.00001)、皮损程度(MD-0.79,95%CI-1.03~-0.54,P<0.00001)和IL-6(MD-69.26 ng/ml,95%CI-82.76~-55.76,P<0.00001)显著降低。结论热敏灸治疗带状疱疹后神经痛具有优势,但因纳入RCT偏倚风险较高及部分结局有显著异质性,结论尚需更多高质量RCT予以验证。

Objective To systematically evaluate the efficacy and safety of heat-sensitive moxibustion for postherpetic neuralgia.Methods Randomized controlled trials assessing heat-sensitive moxibustion for postherpetic neuralgia was systematically searched up to May 10,2020.Outcomes assessed included overall efficacy,visual pain simulation score(VAS),degree of skin lesions,sleep quality,interleukin-6(IL-6)and adverse reactions.Results A total of 15 RCT(n=1032)were included.Meta-analysis showed that heat-sensitive moxibustion significantly improved the overall efficacy(OR 5.81,95%CI 3.69~9.14,P<0.00001)and sleep quality(MD-1.18,95%CI-1.50~-0.85,P<0.00001)and significantly reduce the VAS pain score(MD-1.87,95%CI-2.39~-1.34,P<0.00001),degree of skin lesions(MD-0.79,95%CI-1.03~-0.54,P<0.00001),and level of IL-6(MD-69.26 ng/mL,95%CI-82.76~-55.76,P<0.00001).Conclusion Heat-sensitive moxibustion has advantages in treating postherpetic neuralgia.However,due to the high risk of bias within the included RCTs and significant heterogeneity among some outcomes,the validity of the conclusion needs more high-quality RCT evidence.