针刺治疗腰肌劳损疗效的meta分析

Effect of acupuncture on patients with lumbar muscle strain:a meta-analysis

目的系统评价针刺治疗腰肌劳损的临床疗效。方法通过计算机检索PubMed、Embase、Cochrane Library、中国知网(CNKI)、万方医学网、中国生物医学文献服务系统(CBM)、维普资讯中文期刊服务平台(VIP)等数据库,检索时限为从建库至2021年1月31日,纳入针刺治疗腰肌劳损的随机对照试验(RCT)。由2名研究人员单独进行文献筛选和资料提取,并评估纳入研究的偏倚风险,采用Stata16.0软件进行meta分析。结果最终纳入13项RCT,共1474例患者。针刺联合非针灸疗法总有效率明显高于单纯非针灸疗法,差异有统计学意义[风险比=1.15,95%可信区间(CI):1.08~1.22,P=0.001];针刺疗法总有效率与非针灸疗法比较,差异无统计学意义(风险比=1.04,95%CI:0.94~1.14,P=0.48);针刺联合非针灸疗法在降低疼痛视觉模拟评分方面优于单纯非针灸疗法,差异有统计学意义(均数差=0.64,95%CI:0.20~1.08,P=0.001)。结论在腰肌劳损的治疗中针刺疗法有效且能改善疼痛视觉模拟评分,但总有效率并不优于非针灸疗法。因单一针刺疗效有限,建议联合其他疗法以提高疗效。受纳入研究数量及质量的影响尚需更完善的RCT研究对该结论进行验证。

Objective To systematically evaluate the clinical efficacy of acupuncture in the treatment of lumbar muscle strain.Methods The databases of PubMed,Embase,Cochrane Library,China national knowledge infrastructure(CNKI),WanFang Data,Chinese BioMedical Literature Database(CBM)and VIP were searched to collect randomized controlled trials(RCT)on acupuncture treatment for lumbar muscle strain from inception to January 31,2021.The literature screening and data extraction were performed by two independent reviewers separately,and the risk of bias was assessed for the included studies.Stata16.0 software was used to conduct the meta-analysis.Results A total of 13 RCT involving 1474 patients were included.The results of meta-analysis showed that the total effective rate of acupuncture combined with non-acupuncture therapy was higher than that of the non-acupuncture therapy[RR=1.15,95%CI(1.08-1.22),P=0.001],while there was no significant difference between the acupuncture therapy and the non-acupuncture therapy[RR=1.04,95%CI(0.94-1.14),P=0.48].The acupuncture combined with non-acupuncture therapy was superior to the non-acupuncture therapy in reducing the score of Visual Analogue Scale(VAS)[MD=0.64,95%CI(0.20-1.08),P=0.001].Conclusion In the treatment of lumbar muscle strain,acupuncture is effective and can reduce the VAS score,but the total efficiency is not superior to the non-acupuncture therapy.The combination of acupuncture and non-acupuncture therapy is suggested because of the limited efficacy of acupuncture monotherapy.Due to the limited quantity and quality of the included studies,more well-designed RCT are needed to verify the above conclusions.