不同针灸疗法治疗腰背肌筋膜炎的网状Meta分析

Network Meta-Analysis of Different Acupuncture Therapies in Treatment of Low Back Myofascitis

目的:运用网状Meta分析评价针灸治疗腰背肌筋膜炎的临床疗效。方法:计算机检索中文期刊全文数据库(CNKI)、万方数据库(Wanfang)、维普数据库(VIP)、PubMed、Embase、Cochrane Library中针灸治疗腰背肌筋膜炎的随机对照试验(RCTs),检索时间为建库至2022年4月。结局指标包括总体有效率、疼痛视觉模拟评分(VAS)。由2位研究评价人员独立进行文献筛选和纳入文献的数据提取,并按Cochrane协作网标准进行文献质量评价。运用Stata 15.0绘制各针灸疗法的网状证据图和纳入文献的发表偏倚漏斗图;运用GeMTC 0.14.3软件对各治疗方法进行网状Meta分析,连续性变量用均数差值(MD)表示;二分类变量用比值比(OR)表示。若纳入的研究节点分析后一致性较好(P>0.05),采用一致性模型进行数据分析,并绘制各针灸疗法的概率排序图;若纳入的研究节点分析后一致性较差(P<0.05),采用非一致性模型进行数据分析。结结果果:最终纳入41篇文献,共6528例患者,涉及电针、小针刀、温针灸、普通针刺、浮针、穴位埋线、艾灸、刺络8种针灸疗法。(1)总有效率:电针、小针刀、温针灸、普通针刺、浮针、穴位埋线、艾灸、刺络的总有效率均优于西药(P<0.05);小针刀、浮针、穴位埋线总有效率均优于普通针刺(P<0.05);小针刀、温针灸、浮针、穴位埋线总有效率均优于电针(P<0.05)。(2)VAS评分:小针刀、温针灸、穴位埋线、艾灸的VAS评分均低于电针(P<0.05);小针刀、穴位埋线、艾灸的VAS评分均低于普通针刺(P<0.05);小针刀、温针灸、浮针、穴位埋线、艾灸VAS评分均低于西药(P<0.05);且各针灸疗法的干预措施等级概率排序图显示,穴位埋线成为最优治疗措施的概率最大(P<0.05)。结论:针灸治疗腰背肌筋膜炎总体疗效优于西药,且穴位埋线具有最佳的疗效。

Objective:To evaluate the efficacy of different acupuncture therapies for low back myofascitis through network meta-analysis.Methods:Randomized controlled trials(RCTs)of acupuncture therapy for low back myofascitis were retrieved from CNKI,Wanfang,VIP,PubMed,Embase,Cochrane Library from inception to April 2022.Outcome measures included overall efficiency and visual analogue scale(VAS).Literature screening and data extraction were carried out independently by two researchers,and the literature quality was evaluated according to the Cochrane reviewer’s Handbook.Stata 15.0 was used to draw network plots of each acupuncture therapy and the publication bias funnel plots of the included literature.GEMTC 0.14.3 was used to conduct network meta-analysis for each therapy;and continuous variables were described by mean difference(MD),and dichotomous variables were described by the odds ratio(OR).If the nodes of included studies showed good consistency after analysis(P>0.05),the consistency model was used for data analysis,and the probability ranking diagram of each acupuncture therapy was drawn.If the nodes of included studies had poor consistency after analysis(P<0.05),the non-consistency model was used for data analysis.Results:A total of 41 RCTs were included with 6258 patients,involving eight kinds of acupuncture therapies,including electroacupuncture,akupotomye,warming needle moxibustion,acupuncture,subcutaneous needling,acupoint catgut embedding,moxa-wool moxibustion and blood-letting puncturing.(1)Total effective rate:all included acupuncture therapies were more effective than western medication(P<0.05);akupotomye,subcutaneous needling,and acupoint catgut embedding were all more effective than acupuncture(P<0.05);akupotomye,warming needle moxibustion,subcutaneous needling,acupoint catgut embedding were all more effective than electroacupuncture(P<0.05).(2)VAS score:the VAS scores of akupotomye,warming needle moxibustion,subcutaneous needling acupoint catgut embedding,moxa-wool moxibustion were lower than that of electroacupuncture(P<0.05);and the scores of akupotomye,acupoint catgut embedding,moxa-wool moxibustion were lower than that of acupuncture(P<0.05).The VAS scores of akupotomye,warming needle moxibustion,subcutaneous needling,acupoint catgut embedding,moxa-wool moxibustion were all lower than that of western medication(P<0.05).The probability ranking diagram of intervention measures of each acupuncture therapy showed that the acupoint catgut embedding was the most likely to be the best therapy measure(P<0.05).Conclusion:The therapeutic effect of acupuncture therapies on low back myofascitis is better than that of western medication,and acupoint catgut embedding has the best curative effect.