针刺治疗功能性便秘临床疗效的Meta分析

Clinical effect of acupuncture in treatment of functional constipation: A meta-analysis

目的:系统评价针刺治疗功能性便秘(FC)的临床疗效。方法:计算机检索中国知网(CNKI)、万方数据(WANFANG DATA)、中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)、PubMed、荷兰医学文献数据库(Embase)和Cochrane图书馆(Cochrane Library),搜集自建库至2019年12月31日发表的有关针刺治疗FC的随机对照试验(RCT),对照组采用假针刺治疗,对符合纳入标准的文献进行资料提取和质量评价,应用RevMan 5.3统计软件进行Meta分析。结果:最终纳入13篇RCTs,共2051例患者。Meta分析结果显示:治疗组在提高总有效率(OR=3.56,95%CI[1.70,7.44],Z=3.37,P=0.0007),改善周完全自主排便次数(CSBMs)≥3次患者比例(OR=3.15,95%CI[2.41,4.12],Z=8.38,P<0.00001)、CSBMs[WMD=1.13,95%CI(0.75,1.51),Z=5.81,P<0.00001]、Bristol大便性状量表评分[WMD=0.41,95%CI(0.11,0.70),Z=2.65,P=0.008]、便秘患者生活质量量表(PAC-QOL)评分[WMD=-14.69,95%CI(-25.85,-3.52),Z=2.58,P=0.01]、排便困难程度评分[WMD=-0.27,95%CI(-0.55,-0.00),Z=1.97,P=0.05]方面,均优于对照组。结论:基于目前证据,针刺治疗FC疗效确切,优于假针刺疗法治疗,但仍需要更多高质量、多中心、大样本的RCT进行深入研究。

Objective: To systematically review the clinical effect of acupuncture in the treatment of functional constipation(FC).CNKI,Wanfang Data, CBM,VIP,PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials(RCTs) on acupuncture in the treatment of FC published up to December 31,2019,and the patients in the control group were treated with sham acupuncture.Data extraction and quality assessment were performed for the articles meeting inclusion criteria, and RevMan 5.3 was used for meta-analysis.Results: A total of 13 RCTs were included, with 2051 patients in total.The meta-analysis showed that the treatment group had a significantly better overall response rate than the control group(OR=3.56,95% CI[1.70,7.44],Z=3.37,P=0.0007).Compared with the control group, the treatment group had significantly better improvements in the proportion of patients with weekly complete spontaneous bowel movements(CSBMs) ≥3(OR=3.15,95%CI[2.41,4.12],Z=8.38,P<0.00001),CSBMs [WMD=1.13,95%CI(0.75,1.51),Z=5.81,P<0.00001],Bristol Stool Scale score [WMD=0.41,95%CI(0.11,0.70),Z=2.65,P=0.008],Patient Assessment of Constipation Quality of Life Questionnaire score [WMD=-14.69,95%CI(-25.85,-3.52),Z=2.58,P=0.01],and defecation difficulty score [WMD=-0.27,95%CI(-0.55,-0.00),Z=1.97,P=0.05].Conclusion: Based on current evidence, acupuncture has a marked clinical effect in the treatment of FC and is superior to sham acupuncture, while high-quality multicenter RCTs with a large sample size are needed for in-depth research.