中医适宜技术耳穴压丸疗法防控儿童青少年近视的meta分析

Meta analysis of prevention and control of myopia in children and adolescents by auricular point pressing therapy

目的系统评价耳穴压丸干预儿童青少年近视的效果,为近视防控提供依据。方法计算机检索数据库并筛选耳穴压丸治疗儿童青少年近视的临床随机对照试验研究,检索时限为建库至2020年12月。由2位研究者独立筛选文献,评价纳入研究的偏倚风险,提取资料后采用RevMan 5.3软件进行Meta分析。结果共纳入21篇文献,共计患者2450例(3855只眼),其中耳穴压丸组1995只眼,常规治疗组1860只眼。经Meta分析后结果显示耳穴压丸疗法干预儿童青少年近视的总有效率高于常规治疗,具有统计学意义[OR=2.85,95%CI(2.39,3.41),Z=11.62,P<0.01]。耳穴压丸疗效优于非睫状肌麻痹剂[OR=2.04,95%CI(1.57,2.46),Z=5.37,P<0.01]和睫状肌麻痹剂[OR=3.80,95%CI(2.96,4.87),Z=10.50,P<0.01],差异均有统计学意义。在视力、屈光度方面耳穴压丸疗法优于常规治疗。同时耳穴压丸疗法能延缓眼轴增长、降低眼内压及前房深度,对临床症状如视物模糊、异物感、酸胀不适、干涩、流泪方面也均有改善作用。结论耳穴压丸疗法干预儿童青少年近视疗效显著,且操作简便、安全,患儿依从性好,值得进一步推广。但目前研究质量整体偏低,证据强度不足,因此有必要对其进行大样本、多中心的高质量临床研究,为推广儿童青少年的近视防控提供依据。

OBJECTIVE To systematically evaluate the effect of auricular point therapy on myopia in children and adolescents,so as to provide the basis on the prevention and control of myopia.METHODS Databases were searched by the computer and RCTs of auricular point therapy on myopia in children and adolescents were screened from the establishment of those databases to December 2020.Two researchers screened the literature independently and evaluated the risk of bias included in the study.After extracting the data,Revman 5.3 software was used for meta-analysis.RESULTS A total of 21 studies were included,including 2450 cases(3855 eyes),with 1995 eyes in the auricular point therapy group and 1860 eyes in the routine treatment group.After metaanalysis,the results showed that the total effective rate of auricular point therapy group was higher than that of the the routine treatment group in the preventrion of myopia in children and adolescents,which was statistically significant[OR=2.85,95%CI(2.39,3.41),Z=11.62,P<0.01].The curative effect of auricular point therapy was better than that of non-ciliary muscle paralysis[OR=2.04,95%CI(1.57,2.46),Z=5.37,P<0.01]and ciliary muscle paralysis agent[OR=3.80,95%CI(2.96,4.87),Z=10.50,P<0.01],and the difference was statistically significant.In terms of vision and diopter,auricular point therapy was significantly better than the routine treatment,which at the same time,could delay the growth of ocular axis,reduce intraocular pressure,anterior chamber depth and improve clinical symptoms such as blurred vision,foreign body sensation,acid and swelling,dry eyes,shedding tear.CONCLUSIONS Auricular point therapy has a significant effect on myopia in children and adolescents,which is simple,safe and has good compliance and is worthy to be further promoted.However,at present,the overrall research quality is low and the evidence intensity is insufficient.Therefore,it is necessary to carry out high-quality clinical research with large samples and multi-centers,so as to provide the basis on the prevention and control of myopia in children and adolescents as well as its popularization.