不同针灸疗法治疗冠心病稳定型心绞痛的网状Meta分析

Stable angina pectoris of coronary heart disease treated with different acupuncture and moxibustion therapies:a network Meta-analysis

运用网状Meta分析方法比较不同针灸疗法治疗冠心病稳定型心绞痛(SAP)的临床疗效。计算机检索PubMed、Web of Science、Cochrane Library、中国期刊全文数据库(CNKI)、万方数据知识服务平台(Wanfang)、维普资讯中文期刊服务平台(VIP)2002年5月1日至2022年5月1日针灸治疗冠心病SAP的随机对照试验文献,运用Cochrane 5.3偏倚风险评估工具进行质量评价,Stata 13.1进行网状Meta分析。共纳入29篇文献,涉及针刺、穴位贴敷、艾灸等针灸疗法。穴位贴敷、艾灸、针刺、皮内针联合常规西药治疗改善心绞痛有效率优于单独常规西药治疗(P<0.05),且穴位贴敷联合常规西药治疗成为最优治疗方法的可能性大[曲线下面积(SUCRA)=0.711,P<0.05]。针刺联合常规西药治疗改善心电图有效率优于常规西药治疗(P<0.05),且针刺联合常规西药治疗成为最优治疗方法可能性大(SUCRA=0.800,P<0.05)。针刺、穴位贴敷、艾灸、皮内针联合常规西药治疗均能提高冠心病SAP的临床疗效,但在不同结局指标下,最佳的治疗方式可能有所区别,还需更多多中心、大样本的随机对照试验对结果加以验证。

To compare the clinical efficacy among different acupuncture and moxibustion therapies on stable angina pectoris(SAP)of coronary heart disease by means of network Meta-analysis.The articles of randomized controlled trial(RCT)for SAP of coronary heart disease treated with acupuncture and moxibustion therapies were searched from PubMed,Web of Science,Cochrane Library,CNKI,Wanfang database and VIP database from May 1,2002 to May 1,2022.The quality of them was assessed with the risk of bias assessment tool of Cochrane 5.3,and the network Meta-analysis was undertaken with Stata 13.1 software.A total of 29 articles were included with the acupuncture and moxibustion therapies involved,e.g.acupuncture,acupoint application and moxibustion.In comparison with the simple routine western medication,the effective rate was better on SAP treated with the combined treatments,in which,acupoint application,moxibustion,acupuncture and intradermal needling were combined with routine western medication(P<0.05).Of those combined treatments,the combination of the acupoint application with routine western medication had high probability,suggesting the optimal regimen(area under the curve[SUCRA]=0.711,P<0.05).The effective rate of acupuncture combined with routine western medication for ECG improvement was better than that of routine western medication(P<0.05),and such combined treatment was high in probability,underlying its optimal treatment(SUCRA=0.800,P<0.05).Combined with routine western medication,acupuncture,acupoint application,moxibustion and intradermal needling all improve the clinical efficacy on SAP of coronary heart disease.But,with different outcomes considered,the optimal treatments may be different.It needs more multi-central and large-sample randomized controlled trials to validate these results.