针灸相关疗法治疗卵巢早衰疗效的网状Meta分析

Efficacy of acupuncture-related therapy in the treatment of premature ovarian failure:a network Meta-analysis

目的系统评价针灸相关疗法治疗卵巢早衰(POF)的疗效。方法计算机检索Pubmed、Embase、Cochrance图书馆、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据库(WanFang)及中文科技期刊全文数据库(VIP),筛选出针灸相关疗法治疗POF的临床随机对照试验(RCT),检索时限均为建库至2020年4月6日。由2位研究者独立筛选文献、提取数据和对纳入研究进行风险评价,采用stata 15.1软件进行数据统计分析与作图。结果共纳入32个RCT,涉及11种治疗措施,包括针灸结合、西药、中药+艾灸、穴位埋线、针药结合、埋线+药物、针灸+药物、中药、艾灸、针刺、中药+针灸+耳穴。网状Meta分析结果显示,在临床疗效方面,穴位埋线疗效最好,针灸相关疗法优于单纯中药或西药,排名前5位的治疗措施依次为穴位埋线(85.4%)、针灸结合(70.3%)、针刺(63.1%)、中药+针灸+耳穴(61.6%)、埋线+药物(55.4%);在降低血清卵泡刺激素(FSH)水平方面,针刺疗效更为显著,针灸相关疗法优于单纯中药或西药,排名前5位的治疗措施依次为针刺(97.7%)、穴位埋线(82.2%)、针灸结合(61.9%)、中药+针灸+耳穴(60.3%)、埋线+药物(57.2%)。结论在提高临床疗效与降低血清FSH水平方面,针灸相关疗法比单纯中药或西药治疗疗效更显著,但由于现有研究的局限性,研究结论还需大量设计合理、高质量且方法得当的RCT予以证实。

ObjectiveTo systematically evaluate the clinical effect of acupuncture-related therapies in the treatment of premature ovarian failure(POF).MethodsPubmed,Embase,Cochrance Library,Chinese Biology Medicine disc(CBM),China National Knowledge Infrastructure(CNKI),Wanfang Database(Wang Fang)and VIP Database(VIP)were searched by computer from the date of database establishment to April 6,2020,and the randomized controlled trials(RCTs)of acupuncture-related therapies in treating POF were screened. Two investigators independently screened the literature,extracted data and evaluated the bias risk of the inclusion study. The stata 15.1 software were applied for the statistical analysis of data and plotting.ResultsA total of 32 RCTs were included involving 11 treatment methods,including:acupuncture combined with moxibustion,western medication,Chinese medicinal herbs + moxibustion,acupoint catgut embedding,acupuncture combined with medication,acupoint catgut embedding + medication,acupuncture-moxibustion + medication,Chinese medicinal herbs,moxibustion,acupuncture,Chinese medicinal herbs +acupuncture-moxibustion + auricular point therapy. The network Meta-analysis results showed that,in the aspect of clinical effect,the effect of acupoint catgut embedding was the best,acupuncture-related therapies were superior to Chinese medicinal herbs or western medication only,and the top five treatment methods were acupoint catgut embedding(85.4%),acupuncture combined with moxibustion(70.3%),acupuncture(63.1%),Chinese medicinal herbs + acupuncture-moxibustion + auricular point therapy(61.6%),acupoint catgut embedding + medication(55.4%);in the aspect of decreasing the level of serum follicle stimulating hormone(FSH),the effect of acupuncture was more significant,acupuncturerelated therapies were superior to Chinese medicinal herbs or western medication only,and the top five treatment methods were acupuncture(97.7%), acupoint catgut embedding(82.2%), acupuncture combined with moxibustion(61.9%),Chinese medicinal herbs +acupuncture-moxibustion + auricular point therapy(60.3%),acupoint catgut embedding + medication(57.2%).Conclusion In the aspects of enhancing the clinical effect and reducing the level of serum FSH,the effect of acupuncture-related therapies are more significant than that of Chinese medicinal herbs or western medication only. While due to the limitations of the existing studies,the conclusion of this study needs to be confirmed by a large number of high-quality RCTs with reasonable design and proper methods.