针刺联合刺络拔罐治疗带状疱疹的Meta分析与GRADE评价

Meta-analysis and GRADE Evaluation of Acupuncture Combined with Bloodletting Puncture and Cupping Therapy in the Treatment of Herpes Zoster

【目的】系统评价针刺联合刺络拔罐治疗带状疱疹的疗效及安全性。【方法】计算机检索中国知网(CNKI)、中国生物医学文献数据库(SinoMed)、万方数据库(WanFang)、维普中文科技期刊全文数据库(VIP)、Medline、Embase、Cochrane Library等数据库。收集关于针刺联合刺络拔罐治疗带状疱疹的随机对照试验(RCT)。采用Review Manager 5.3软件对纳入文献进行Meta分析,使用GRADE Profiler 3.6进行证据级别评价。【结果】共纳入20篇文献进行Meta分析,共1 530例患者。Meta分析结果显示:与常规西药相比,针刺联合刺络拔罐治疗带状疱疹总有效率更高[OR=5.87,95%CI(3.89,8.84),P<0.000 01],降低VAS评分更具优势[WMD=-2.37,95%CI(-2.70,-2.03),P<0.000 01],结痂时间更短[WMD=-1.99,95%CI(-3.48,-0.50),P=0.009],带状疱疹后遗神经痛发生率更低[OR=0.11,95%CI(0.03,0.41),P=0.000 9],安全性评价显示两者差异无统计学意义[OR=0.24,95%CI(0.03,0.22),P=0.21]。【结论】针刺联合刺络拔罐治疗带状疱疹疗效更好且未见明显不良反应。但受纳入研究质量的限制,本研究结论尚需更多高质量的RCT进一步验证。

Objective To evaluate the therapeutic efficacy and safety of acupuncture combined with blood-letting puncture and cupping therapy in treating herpes zoster. Methods The databases including CNKI, SinoMed,WanFang,VIP,Medline,Embase and Cochrane Library were retrieved from computer. Randomized controlled trials(RCTs)of acupuncture combined with blood-letting puncture and cupping therapy for herpes zoster were collected. Review Manager 5.3 software was used for meta-analysis of the included literatures, and GRADE Profiler 3.6 was used to evaluate the level of evidence. Results A total of 20 publications with 1 530 patients were included to do the Meta-analysis,and the results of the Meta-analysis showed that the acupuncture combined with blood-letting puncture and cupping therapy was more effective in treating herpes zoster than conventional western medicine[OR=5.87,95% CI(3.89,8.84),P<0.000 01],with a superior advantage in reducing VAS scores[WMD=-2.37, 95%CI(-2.70,-2.03), P<0.000 01], shorter scabbing time[WMD=-1.99, 95%CI(-3.48,-0.50),P = 0.009],lower incidence of postherpetic neuralgia[OR=0.11,95% CI(0.03,0.41),P =0.00 09], and safety evaluation showed no statistically significant difference between the two groups[OR=0.24,95% CI(0.03,0.22),P = 0.21]. Conclusion Acupuncture combined with blood-letting puncture and cupping therapy was more effective in treating herpes zoster and no significant adverse effects were found. However,due to the quality of the included studies,the findings of this study need to be further validated by more high-quality RCTs.