益肺灸治疗慢性阻塞性肺疾病临床疗效的文献评价和Meta分析

Literature evaluation and meta-analysis of clinical effect of lung benefiting moxibustion on chronic obstructive pulmonary disease

目的评价益肺灸治疗慢性阻塞性肺疾病(COPD)的临床疗效。方法检索中国知网、PubMed等数据库从建库至2021年5月公开发表的益肺灸治疗COPD的随机对照试验(RCT),按照纳入排除标准筛选文献,对文献质量进行评价,双人独立提取研究数据,采用RevMan5.3软件对结局指标(急性加重次数、呼吸困难、肺功能等)进行Meta分析。结果共筛选107篇文献,纳入15个研究,1355例患者。对照组为西医常规治疗,试验组在对照组基础上进行益肺灸(督灸)治疗。由于受外治法技术限制,导致文献方法学质量较低,风险偏倚较大。Meta分析结果显示:呼吸困难评分[95%CI(-0.40~-0.09),P<0.05],6 min步行距离(6MWD)[95%CI(20.15~52.08),P<0.05],1 s用力呼吸容积(FEV1)%[95%CI(3.36~9.52),P<0.05]等12个结局指标组间差异具有统计学意义,不良反应发生率较低,未见卫生经济学评价报告。结论益肺灸治疗COPD稳定期患者能够改善呼吸困难,提高生存质量,减少COPD急性加重,提高运动耐力,改善临床症状,改善肺功能。所得结论有待高质量临床研究进一步证实。加强外治法盲法设计有助于提高益肺灸技术循证研究质量和水平;加强卫生经济学评价,能够更客观评价益肺灸技术的比较效益。

Objective To evaluate the clinical effect of lung benefiting moxibustion on chronic obstructive pulmonary disease(COPD).Methods Randomized controlled trials(RCT)of lung benefiting moxibustion treatment of COPD were retrieved from China national knowledge infrastructure,PubMed and other databases from establishment to publication in May 2021.Literatures were screened according to inclusion and exclusion criteria,two persons independently extracted study data,and literature quality was evaluated by meta-analysis of outcome indicators(number of acute exacerbations,dyspnea,lung function and so on)using RevMan5.3 software.Results A total of 107 literatures were screened and 1355 patients were included in 15 studies.The control group was treated with conventional Western medicine,and the experimental group was given lung benefiting moxibustion or du moxibustion therapy on the basis of the control group.Due to the technical limitations of external treatment,the quality of literature methodology was low and the risk bias was large.Meta analysis results showed as follows:dyspnea score[95%CI(-0.40,-0.09),P<0.05],6 min walking distance(6MWD)[95%CI(20.15,52.08),P<0.05],forced expiratory volume in 1 s(FEV1)%[95%CI(3.36,9.52),P<0.05]and other 12 outcome indicators were statistically significant between groups.The incidence of adverse reactions was low.No health economics evaluation report was found.Conclusions Lung benefiting moxibustion treatment of stable COPD patients could improve dyspnea and quality of life,reduce acute exacerbation of COPD,improve exercise endurance,clinical symptoms and lung function.The conclusions need to be further confirmed by high-quality clinical studies.Strengthening the design of blind external treatment is helpful to improve the quality and level of evidence-based research on lung benefiting moxibustion technology.Strengthening the evaluation of health economics could more objectively evaluate the comparative benefit of lung benefiting moxibustion technology.