针灸联合穴位贴敷治疗腹泻型肠易激综合征的Meta分析

Meta-analysis of Acupuncture Combined with Acupoint Application in the Treatment of Diarrhea-type Irritable Bowel Syndrome

目的 通过对针灸联合穴位贴敷治疗腹泻型肠易激综合征的临床疗效、安全性进行Meta分析,为临床运用针灸联合穴位贴敷治疗腹泻型肠易激综合征提供循证依据。方法 运用中国知网、万方、维普、中国生物医学文献服务系统、Pubmed等数据库检索近20年针灸联合穴位贴敷治疗腹泻型肠易激综合征的文献,通过纳入及排除标准筛选文献,运用Excel 2019提取并整理原始数据,使用Jadad量表、Cochrane偏倚风险评估工具评估纳入研究的质量及偏倚风险,使用RevMan 5.3进行Meta分析。结果 最终纳入RCT研究10项,共计832例患者。在总有效率[RR=1.26,95%CI(1.17,1.36),P<0.000 01]、症状积分[SMD=-1.44,95%CI(-2.16,-0.73),P<0.000 01]、IBS-QOL[SMD=0.59,95%CI(-0.14,1.33),P<0.000 1]等方面,针灸联合穴位贴敷较西药治疗具有优势。在安全性方面,7项研究未提及不良反应,2项研究报告了具体不良反应情况,1项研究提及了研究过程中无不良反应。结论 针灸联合穴位贴敷治疗较西药治疗更能提高腹泻型IBS的疗效、改善患者的临床症状、提高患者的生活质量。该治疗方案的安全性目前尚不能予以肯定或否定的评价,仍需进一步研究论证。

Objective To conduct a Meta-analysis on the clinical efficacy and safety of acupuncture combined with acupoint application in the treatment of diarrhea-type irritable bowel syndrome(IBS-D), and to provide evidence for the clinical application of acupuncture combined with acupoint application in the treatment of IBS-D. Methods The literature on the treatment of IBS-D by acupuncture combined with acupoint application in the past 20 years was searched on databases such as CNKI, Wanfang, VIP, China Biomedical Literature Service System, Pubmed, etc. The original data was extracted and organized using Excel 2019. Jadad scale and Cochrane risk of bias assessment tool were used to assess the quality and risk of bias of the included studies. RevMan 5.3 was used for Meta-analysis. Results Ten RCT studies were included, which involves a total of 832 patients. Acupuncture combined with acupoint application has advantages over western medicine in overall response rate [RR=1.26, 95%CI(1.17, 1.36), P<0.000 01], symptom score [SMD=-1.44, 95%CI(-2.16,-0.73), P<0.000 01], and IBS-QOL [SMD=0.59, 95%CI(-0.14, 1.33), P<0.000 1]. In terms of safety, 7 studies did not mention adverse reactions, 2 studies reported specific adverse reactions, and 1 study mentioned that there were no adverse reactions during the study. Conclusion Acupuncture combined with acupoint application therapy can enhance the curative effect of IBS-D, improve the clinical symptoms of patients, and improve the quality of life of patients compared with Western medicine. The safety of this treatment regimen cannot be evaluated at present, which requires further research and demonstration.