针灸治疗儿童抽动障碍的网状Meta分析

Network Meta-Analysis of Acupuncture and Moxibustion for Tic Disorder

目的采用网状Meta分析方法评价单纯西药,单纯针刺,针刺+耳穴,电针,刺灸治疗儿童抽动障碍的有效性及安全性。方法计算机检索中国知网、维普、万方、PubMed、Embase、CBM数据库,收集针灸疗法治疗儿童抽动障碍的随机对照研究(Randomized controlled trial,RCT),检索时限均为建库至2021年5月1日。采用Stata 15.0软件和WinBUGS软件进行数据分析。结果共纳入18个RCT,包括1380例患者,涉及单纯西药治疗和4种针灸疗法。网状Meta分析结果显示:在治疗效果方面,单纯针刺,针刺+耳穴,电针,刺灸均优于单纯西药治疗,其中针刺+耳穴疗效最佳;在不良反应发生率方面,单纯西药治疗明显高于单纯针刺,针刺+耳穴,刺灸疗法,其中刺灸疗法不良反应发生率最低,针刺与针刺+耳穴次之。结论临床治疗小儿抽动症时可优先选择针刺+耳穴,然而多种治疗方法各有优劣,应结合临床实际情况及中医辨证选择恰当的治疗方式。

Objective To evaluate the efficacy andsafety of western medicine,acupuncture,acupuncture+ear points,electropuncture,and acupuncture+moxibustion in the treatment of tic disorder(TD).Methods Randomized controlled trials(RCTs)on the treatment of TD with acupuncture and moxibustion were retrieved from China National Knowledge Infrastructure(CNKI),VIP,Wangfang Data,PubMed,Embase,and CBM(from inception to May 1,2021)and Stata15.0 andWinBUGS were employed for data analysis.Results A total of 18 RCTs were screened out,involving 1380 patients and the 5 therapies.According to the network Meta-analysis,the clinical efficacy of acupuncture,acupuncture+ear points,electropuncture,and acupuncture+moxibustionwas better than that of western medicine,particularly theacupuncture+ear points.The incidence of adverse reactions induced by western medicine was significantly higher than that by acupuncture,acupuncture+ear points,and acupuncture+moxibustion.The incidence was the lowest in the treatment by andacupuncture+moxibustion,followed by acupuncture,andacupuncture+ear points.Conclusion In the clinical treatment of TD,acupuncture+ear points is the first choice,and other therapies should be selected based on the conditions of patients and syndrome differentiation.