刺络拔罐法治疗急性期带状疱疹有效性和安全性的系统评价及Meta分析

Systematic Review and Meta-analysis on Efficacy and Safety of BloodLetting Puncture and Cupping Therapy for Acute Herpes Zoster

【目的】系统评价刺络拔罐疗法治疗急性期带状疱疹的有效性和安全性。【方法】通过计算机检索中国知网期刊全文数据库(CNKI)、维普数据库(VIP)、万方数据知识服务平台(Wanfang)、中国生物医学文献服务系统(SinoMed)、美国医学在线(PubMed)、EMBase、国际循证医学图书馆(Cochrane Library)等数据库,检索时限从建库至2019年12月,收集关于刺络拔罐法治疗急性期带状疱疹的随机对照试验。采用Cochrane偏倚风险评估工具对纳入研究进行质量评价,采用Revman 5.3统计软件进行Meta分析。【结果】最终纳入18项研究,共1 503例受试者。Meta分析结果显示,单刺络拔罐法或刺络拔罐联合针灸法与抗病毒药(阿昔洛韦、泛昔洛韦、伐昔洛韦)相比,VAS评分[MD=-1.83,95%CI(-2.24,-1.42),P<0.000 01]、疼痛缓解30%的时间[MD=-4.39,95%CI(-5.66,-3.11),P<0.000 01]、疼痛持续时间[MD=-1.94,95%CI(-2.71,-1.17),P<0.000 01]、止疱时间[MD=-0.82,95%CI(-0.98,-0.67),P<0.000 01]、后遗神经痛发生率[MD=0.13,95%CI(0.05,0.33),P<0.000 1],差异有统计学意义,提示刺络拔罐或刺络拔罐联合针灸的疗效优于抗病毒药(阿昔洛韦、泛昔洛韦、伐昔洛韦)。且纳入研究中刺络拔罐或刺络拔罐联合针灸均未出现不良事件。【结论】刺络拔罐或刺络拔罐联合针灸疗法治疗急性期带状疱疹具有一定的有效性和安全性,但由于纳入研究质量不高,有待更多大样本、高质量、规范的随机对照试验,提供更加客观可靠的临床决策依据。

Objective To systematically evaluate the efficacy and safety of blood-letting puncture and cupping therapy for acute herpes zoster. Methods The randomized controlled trials of acupuncture and cupping for the treatment of acute herpes zoster from the time of database establishment to December 2019 were collected by retrieving the databases such as CNKI,VIP,Wanfang,SinoMed,PubMed,EMBase and Cochrane Library.The Cochrane bias risk assessment tool was used to evaluate the quality of the included studies,and Revman 5.3 statistical software was performed for Meta-analysis. Results Finally,18 studies with a total of 1 503 subjects were included. The results of Meta-analysis showed that comparing blood-letting puncture and cupping therapy alone or blood-letting puncture and cupping therapy combined with acupuncture and moxibustion with antivirals(acyclovir,famciclovir,and valaciclovir),the VAS score was [MD=-1.83,95% CI(-2.24,-1.42),P <0.000 01] and the time for pain relief of 30% [MD=-4.39,95%CI(-5.66,-3.11),P < 0.000 01],duration of pain [MD=-1.94,95%CI(-2.71,-1.17),P < 0.000 01],stopping time of herpes [MD=-0.82,95%CI(-0.98,-0.67),P < 0.000 01],the incidence of residual neuralgia [MD=0.13,95%CI(0.05,0.33),P <0.0001],and the differences were statistically significant. It is suggested that the curative effect of blood-letting puncture and cupping therapy alone or blood-letting puncture and cupping therapy combined with acupuncture and moxibustion is superior to that of antiviral drugs(acyclovir,famciclovir and valacyclovir). In addition,there were no adverse events occurred in any of the included studies. Conclusion Blood-letting puncture and cupping therapy alone or blood-letting puncture and cupping therapy combined with acupuncture and moxibustion exerts certain effect and safety in the treatment of acute herpes zoster. However,due to the low quality of the included studies,more of large-sample,high-quality and standardized randomized controlled trials are needed in order to provide a more objective and reliable clinical decision basis.