近10年针灸治疗成人膀胱过度活动症的Meta分析

Meta-analysis of acupuncture-moxibustion treatment of overactive bladder in adults in the past decade

目的以单独口服西药作对照,系统评估单独针灸治疗成人膀胱过度活动症(OAB)的有效性和安全性,为针灸治疗OAB提供循证参考。方法系统检索中国知网(CNKI)、万方学术期刊全文数据库(Wanfang)、重庆维普数据库(CQVIP)、中国生物医学文献数据库(CBM)、PubMed、Cochrane Library及荷兰医学文摘(EMBASE)数据库。纳入文献的发表时间为2011年1月至2021年4月。采用Cochrane评价方法进行风险偏倚评估。使用RevMan 5.3软件进行Meta分析。使用标准均数差(SMD)、可信区间(CI)及风险比(RR)进行统计描述。结果筛选后最终得到8篇文献,均为随机对照研究。根据干预措施进行分组分析。在排尿症状方面,与单独口服西药相比,针刺配合灸法可更有效减少24 h内的排尿次数[P=0.01,SMD=−0.57,95%CI(−1.02,−0.12)]和24 h内夜尿次数[P=0.03,SMD=0.49,95%CI(0.05,0.94)],降低OAB症状评分(OABSS)[P<0.001,SMD=−3.67,95%CI(−4.48,−2.86)];而在24 h内尿急次数[P=0.38,SMD=−0.17,95%CI(−0.57,0.22)]、24 h内急迫性尿失禁次数[P=0.25,SMD=0.26,95%CI(−0.18,0.70)]和单次排尿量[P=0.22,SMD=1.15,95%CI(−0.70,3.00)]方面,针刺配合灸法与单独口服西药差异无统计学意义。在24 h内排尿次数[P=0.46,SMD=0.07,95%CI(−0.12,0.26)]、24 h内尿急次数[P=0.18,SMD=0.70,95%CI(−1.71,0.32)]、24 h内夜尿次数[P=0.46,SMD=−0.71,95%CI(−2.60,1.17)]、24 h内急迫性尿失禁次数[P=0.08,SMD=−0.22,95%CI(−0.48,0.03)]、单次排尿量[P=0.09,SMD=0.17,95%CI(−0.02,0.36)]和OABSS[P=0.96,SMD=−0.07,95%CI(-2.65,2.52)]方面,针刺/电针与单独口服药物差异无统计学意义。相较于单独口服西药,灸法可更有效减少24 h内排尿次数[P<0.001,SMD=-6.53,95%CI(−7.65,−5.44)]及24 h内尿急次数[P<0.001,SMD=−1.6,95%CI(−2.85,−0.36)]。在不良反应发生率方面,针刺配合灸法的不良反应发生率低于口服药物组[P=0.002,RR=0.07,95%CI(0.01,0.37)];针刺/电针的不良反应发生率与口服药物无统计学差异[P=0.40,RR=0.57,95%CI(0.16,2.12)]。结论针灸疗法在改善OAB患者异常排尿症状方面与单独口服西药作用相当,且具有更高的安全性。

Objective To systematically assess the effectiveness and safety of using acupuncture-moxibustion therapy alone to treat adult overactive bladder(OAB)by taking oral Western medication solely as the control,and to provide evidence-based reference for acupuncture-moxibustion treatment of OAB.Methods A systemic search was conducted through China National Knowledge Infrastructure(CNKI),Wanfang Academic Journal Full-text Database(Wanfang),Chongqing VIP Database(CQVIP),China Biology Medicine Disc(CBM),PubMed,Cochrane Library,and Excerpta Medica Database(EMBASE).RevMan 5.3 was used for meta-analysis.Statistical descriptions were made using standardized mean difference(SMD),confidence interval(CI),and risk ratio(RR).Results Eight randomized controlled studies were finally recruited and were analyzed after being grouped according to intervention methods.Regarding urinary symptoms,compared with sole use of oral Western medication,acupuncture plus moxibustion can more effectively reduce 24 h urinary frequency[P=0.01,SMD=−0.57,95%CI(−1.02,−0.12)],24 h nocturia frequency[P=0.03,SMD=0.49,95%CI(0.05,0.94)],and OAB syndrome score(OABSS)[P<0.001,SMD=−3.67,95%CI(−4.48,−2.86)].Acupuncture combined with moxibustion and oral Western medication work equivalently in comparing 24 h urinary urgency frequency[P=0.38,SMD=−0.17,95%CI(−0.57,0.22)],24 h urgent incontinence frequency[P=0.25,SMD=0.26,95%CI(−0.18,0.70)],and single voiding volume[P=0.22,SMD=1.15,95%CI(−0.70,3.00)].There were no significant differences between acupuncture/electroacupuncture and oral medication in comparing 24 h urinary frequency[P=0.46,SMD=0.07,95%CI(−0.12,0.26)],24 h urinary urgency frequency[P=0.18,SMD=0.70,95%CI(−1.71,0.32)],24 h nocturia frequency[P=0.46,SMD=−0.71,95%CI(−2.60,1.17)],24 h urgent incontinence frequency[P=0.08,SMD=−0.22,95%CI(−0.48,0.03)],single voiding volume[P=0.09,SMD=0.17,95%CI(−0.02,0.36)],or OABSS[P=0.96,SMD=−0.07,95%CI(−2.65,2.52)].Compared with oral Western medication,moxibustion can more effectively reduce 24 h urinary frequency[P<0.001,SMD=−6.53,95%CI(−7.65,−5.44)]and 24 h urinary urgency frequency[P<0.001,SMD=−1.6,95%CI(−2.85,−0.36)].In comparing the adverse reaction rate,acupuncture-moxibustion was associated with a lower rate compared with oral medication[P=0.002,RR=0.07,95%CI(0.01,0.37)],but the difference was statistically insignificant between acupuncture/electroacupuncture and oral medication[P=0.40,RR=0.57,95%CI(0.16,2.12)].Conclusion Acupuncture-moxibustion is equivalent to the sole use of oral Western medication in improving urinary symptoms in OAB patients and has a higher safety rating.