针灸治疗带状疱疹疗效及镇痛效应的Meta分析及系统评价

Meta⁃analysis and systematic evaluation of the curative effect and analgesic effect of acupuncture on herpes zoster

目的:系统评价针灸对比西药治疗带状疱疹的临床疗效及镇痛效应。方法:通过检索中国知网、万方数据库、维普、CMB、PubMed、Embase、Cochrane数据库中关于针灸与西药治疗带状疱疹的随机对照试验研究,检索时限均为2010年1月~2020年7月。采用RevMan5.3软件进行Meta分析。结果:共纳入30组随机对照研究,共涉及4292例患者,根据试验组干预措施不同,进行亚组分析。结果显示:(1)总有效率亚组分析示:单纯针灸治疗亚组合并效应量[RR=1.10,95%CI(1.05,1.15),P<0.0001]。针灸联合西药治疗亚组合并结果[RR=1.16,95%CI(0.86,1.57),P=0.33],提示针灸治疗带状疱疹疗效优于西药治疗,但针灸联合西药治疗并不能提高西药的临床疗效。由于针灸联合西药治疗亚组Meta分析结果不稳健,故该结果需谨慎对待,仍需临床进一步验证。(2)VAS评分改善程度分析示:单纯针灸治疗亚组合并效应量[RR=2.20,95%CI(1.53,2.87),P<0.00001]。针灸联合西药治疗亚组合并效应量[RR=1.12,95%CI(0.39,1.85),P=0.002],提示针灸在改善带状疱疹疼痛上明显优于西药,西药联合针灸可以提高止痛效果。(3)后遗症发生率亚组分析示:30 d后遗症发生率单纯针灸治疗合并效应量[RR=0.34,95%CI(0.25,0.48),P<0.00001],针灸联合西药治疗亚组合并效应量[RR=0.18,95%CI(0.05,0.69),P=0.01]。60 d后遗症发生率单纯针灸治疗合并效应量[RR=0.38,95%CI(0.23,0.62),P=0.0001];90 d后遗症发生率单纯针灸治疗合并效应量[RR=0.39,95%CI(0.20,0.74),P=0.004],提示针灸治疗带状疱疹后遗神经痛发生率明显低于西药,西药联合针灸可降低带状疱疹后遗神经痛发生率。(4)疼痛开始缓解的时间分析示:单纯针灸治疗亚组合并效应量[RR=−2.32,95%CI(−2.48,−2.17),P<0.00001]。针灸联合西药治疗亚组合并效应量[RR=−2.39,95%CI(−2.70,−2.09),P<0.00001],提示针灸镇痛起效时间短于西药,西药联合针灸可以加快镇痛起效时间。(5)疼痛消失的时间分析示:单纯针灸治疗亚组合并效应量[RR=−10.80,95%CI(−12.49,−9.01),P<0.00001]。针灸联合西药治疗亚组合并效应量[RR=−5.98,95%CI(−11.55,−0.41),P=0.04],提示针灸治疗带状疱疹能明显减少疼痛时间,联合西药可以缩短疼痛时间。结论:针灸治疗带状疱疹在总有效率、疼痛缓解及后遗神经症发生率方面显著优于西药;针灸联合西药可提高镇痛效应,降低后遗神经症发生率。鉴于本研究纳入文献总体质量较低,故本结论仍需进一步临床验证。

Objective:To systematically evaluate the clinical efficacy and analgesic effects of acupuncture versus western medicine in the treatment of herpes zoster.Methods:A randomized controlled trial study on acupuncture and western medicine in the treatment of herpes zoster was searched through China HowNet,Wanfang database,Weipu,CMB,PubMed,Embase,Co⁃chrane database,and Meta analysis was performed using RevMan5.3 software.Results:A total of 30 groups of randomized con⁃trolled studies were included,involving a total of 4292 patients.According to the different interventions of the experimental group,subgroup analysis was performed.The results were as follows:(1)The total effective rate subgroup analysis showed:the subcombination of acupuncture and moxibustion treatment alone had a combined effect size[RR=1.10,95%CI(1.05,1.15),P<0.0001].Acupuncture combined with western medicine treatment sub⁃combination results[RR=1.16,95%CI(0.86,1.57),P=0.33].Acupuncture and moxibustion was better than western medicine in the treatment of herpes zoster.But acupuncture com⁃bined with western medicine did not improve the clinical efficacy of western medicine.However,the results of the meta⁃analysis of acupuncture and western medicine treatment subgroups were not robust,this result needs to be treated with caution and further clinical verification is still needed.(2)The analysis of the degree of improvement of the VAS score showed that the combined ef⁃fect of acupuncture and moxibustion treatment was[RR=2.20,95%CI(1.53,2.87),P<0.00001].Acupuncture combined with western medicine treatment sub⁃combination combined effect size[RR=1.12,95%CI(0.39,1.85),P=0.002],indicating that acupuncture was significantly better than western medicine in improving herpes zoster pain,and western medicine combined with acupuncture can improve the analgesic effect.(3)Subgroup analysis of the incidence of sequelae showed that:the incidence of se⁃quelae at 30 days was the combined effect of acupuncture and moxibustion treatment[RR=0.34,95%CI(0.25,0.48),P<0.00001],the combined effect of acupuncture and moxibustion combined with western medicine treatment sub⁃combination[RR=0.18,95%CI(0.05,0.69),P=0.01].The incidence of sequelae after 60 days of simple acupuncture and moxibustion combined with effect size[RR=0.38,95%CI(0.23,0.62),P=0.0001];the incidence of sequelae at 90 days The combined effect size[RR=0.39,95%CI(0.20,0.74),P=0.004],indicating that the incidence of postherpetic neuralgia in acupuncture treatment is signifi⁃cantly lower than that of western medicine.Western medicine combined with acupuncture can reduce the incidence of postherpetic neuralgia rate.(4)The analysis of the time when the pain began to relieve showed:the sub⁃combination of acupuncture and moxi⁃bustion treatment alone combined effect size[RR=−2.32,95%CI(−2.48,−2.17),P<0.00001].Acupuncture combined with western medicine treatment sub⁃combination combined effect amount[RR=−2.39,95%CI(−2.70,−2.09),P<0.00001],suggesting that the onset time of acupuncture and moxibustion analgesia was shorter than that of western medicine.Western medi⁃cine combined with acupuncture can speed up the analgesic onset time.(5)Analysis of the time of pain disappearance showed that the sub⁃combination effect of acupuncture treatment alone was[RR=−10.80,95%CI(−12.49,−9.01),P<0.00001].Acu⁃puncture combined with western medicine treatment sub⁃combination combined effect[RR=−5.98,95%CI(−11.55,−0.41),P=0.04],suggesting that acupuncture treatment of herpes zoster can significantly reduce the pain time,and the combination of western medicine can shorten the pain time.Conclusion:Acupuncture treatment of herpes zoster is significantly better than western medicine in terms of total effective rate,pain relief and incidence of sequelae neurosis;acupuncture and moxibustion combined with western medicine can improve the analgesic effect and reduce the incidence of sequelae neurosis.In view of the low quality of the literature included in this study,this conclusion still needs further clinical verification.