背俞穴刺络拔罐疗法治疗寻常痤疮随机对照试验的Meta分析

Blood-letting puncture and cupping at back-shu points for the treatment of acne vulgaris:a network Meta-analysis of randomized controlled trials

目的系统评价背俞穴刺络拔罐疗法对比其他疗法治疗寻常痤疮的有效性及安全性,以期为背俞穴刺络拔罐法治疗寻常痤疮提供循证学依据。方法按制定的检索策略,对中国期刊全文数据库(CNKI)、万方数据知识服务平台(Wanfang)、中国生物医学文献数据库(SinoMed)、维普资讯中文期刊服务平台(VIP)、PubMed、Cochrane library、Embase、Web of Science等数据库从建库至2021年6月3日所收录的文献进行检索。按制定的纳入及排除标准筛选随机对照试验研究,应用Cochrane系统评价手册对确定纳入的研究进行质量评价,应用RevMan5.4软件进行Meta分析,应用GRADEpro GDT对所有结局指标进行证据的质量评价。结果共纳入13项研究,共1108例寻常痤疮患者。Meta分析显示,试验组总有效率优于对照组(RR=1.18,95%CI:1.13~1.24,Z=7.29,P<0.05);试验组皮损评分改善优于对照组(SMD=-0.89,95%CI:-1.24~-0.54,Z=4.98,P<0.05);试验组在降低Qol-Acne量表评分方面优于对照组(MD=12.45,95%CI:6.95~17.94,Z=4.44,P<0.05);试验组在降低复发率方面优于对照组(RR=0.27,95%CI:0.13~0.53,Z=3.73,P<0.05);试验组在降低血清睾酮水平(<18岁)方面优于对照组(MD=-3.99,95%CI:-5.69~-2.29,Z=4.59,P<0.05);试验组在降低血清睾酮水平(≥18岁)方面优于对照组(MD=-1.35,95%CI:-2.26~-0.44,Z=2.90,P<0.05)。GRADE证据质量评价结果显示以上结局指标证据质量级别均为极低。共7篇文献提及不良反应的发生情况,仅1篇文献报道发生2例轻微不良反应,余均报告无不良反应发生。结论现有证据表明相较于其他疗法,背俞穴刺络拔罐法治疗寻常痤疮远期及近期疗效更佳,安全性高,且患者易于接受。但由于纳入研究较少且质量普遍不高,此结论具有一定局限性,有待更多高质量研究进一步验证。

Objective To systematically evaluate the efficacy and safety of blood-letting puncture and cupping at back-shu points compared with other treatments in the treatment of acne vulgaris,providing evidence-based support for the treatment of acne vulgaris by pricking blood and cupping therapy at back-shu points.Methods According to the established retrieval strategy,literature,included in databases such as China Journal Full Text Database(CNKI),Wanfang Data Knowledge Service Platform(Wanfang),China Biomedical Literature Database(SinoMed),VIP,PubMed,Cochrane library,Embase and Web of Science,was retrieved from the establishment of the database to June 3,2021.Qualified randomized controlled trials were screened according to the established inclusion and exclusion criteria,and the quality of the included studies was evaluated using the Cochrane systematic evaluation manual.Meta-analysis was performed with RevMan 5.4 software,and the quality of evidence for all outcome indicators was evaluated with GRADEpro GDT.Results A total of 13 studies involving 1108 patients with acne vulgaris were included.Meta-analysis showed that the total effective rate of the experimental group was better than that of the control group(RR=1.18,95%CI:1.13 to 1.24,Z=7.29,P<0.05);the improvement of skin lesion score in experimental group was better than that in control group(SMD=-0.89,95%CI:-1.24 to-0.54,Z=4.98,P<0.05);the comparison of Qol-Acne scale score in the experimental group was better than that in the control group(MD=12.45,95%CI:6.95 to 17.94,Z=4.44,P<0.05);the recurrence rate of the experimental group was better than that of the control group(RR=0.27,95%CI:0.13 to 0.53,Z=3.73,P<0.05);the serum testosterone level(<18 years old)in experimental group was better than that in control group(MD=-3.99,95%CI:-5.69 to-2.29,Z=4.59,P<0.05);the level of serum testosterone(≥18 years old)in experimental group was better than that in control group(MD=-1.35,95%CI:-2.26~-0.44,Z=2.90,P<0.05).The GRADE evidence quality evaluation results show that the evidence quality level of the above outcome indicators is extremely low.A total of 7 articles mentioned the occurrence of adverse reaction,with only 1 article reporting 2 cases of mild adverse reaction,while the rest reported no adverse reaction.Conclusions Existing evidence shows that compared to other therapies,the treatment of acne vulgaris with blood-letting puncture and cupping at back-shu points has better long-term and short-term efficacy,high safety and easy to be accepted by patients.However,due to the small number of included studies and generally low quality,this conclusion has certain limitations and needs further verification from more high-quality studies.