针灸治疗慢性阻塞性肺疾病稳定期的网状Meta分析

Acupuncture and moxibustion in treatment of chronic obstructive pulmonary disease at stable stage:a network Meta-analysis

采用网状Meta分析方法评价不同针灸方法治疗慢性阻塞性肺疾病(COPD)稳定期的疗效。计算机检索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)、中国生物医学文献数据库(SinoMed)和PubMed、EMbase、Web of Science、Cochrane Library数据库中针灸治疗COPD稳定期的随机对照试验(RCT)文献,检索时间为建库至2022年3月20日。采用R4.1.1、Stata16.0与Rev Man5.3软件进行数据分析。共纳入48项RCT,包括针灸干预措施15种,样本量3900例。网状Meta分析结果显示:(1)第一秒用力呼气容积占预计值百分比(FEV1%):督灸联合常规治疗、扶阳灸联合常规治疗均优于常规治疗(P<0.05),且督灸联合常规治疗优于穴位埋线联合常规治疗、温针灸(P<0.05);(2)COPD评估测试(CAT)评分:扶阳灸联合常规治疗、温和灸联合常规治疗均优于常规治疗(P<0.05),且扶阳灸联合常规治疗优于穴位埋线联合常规治疗(P<0.05);(3)六分钟步行距离(6MWD):针刺联合常规治疗优于穴位埋线联合常规治疗和常规治疗(P<0.05)。在提高FEV1%方面,督灸联合常规治疗的疗效最佳;在改善CAT评分方面,扶阳灸联合常规治疗的疗效最佳;在增加6MWD方面,针刺联合常规治疗的疗效最佳。受限于纳入文献的质量与数量,该结论仍需高质量RCT进一步验证。

The efficacy on chronic obstructive pulmonary disease(COPD)at stable stage treated with different methods of acupuncture and moxibustion was evaluated using network Meta-analysis method.The articles of the randomized controlled trial(RCT)on stable COPD treated with acupuncture and moxibustion were searched electronically in CNKI,Wanfang,VIP,SinoMed,PubMed,EMbase,Web of Science and Cochrane library.The search was conducted from the inception of the databases to March 20th,2022.Data analysis was performed using R4.1.1,Stata16.0 and RevMan5.3 softwares.A total of 48 RCTs were included,involving 15 kinds of acupuncture and moxibustion interventions and a sample size of 3900 cases.The results of network Meta-analysis showed that:For the forced expiratory volume in one second predicted(FEV,%),both the governor vessel moxibustion combined with conventional treatment(G+C therapy)and the yang-supplementing moxibustion combined with conventional treatment(Y+C therapy)obtained the better effect than that of the conventional treatment(P<0.05),and the G+C therapy was more effective compared with the thread-embedding therapy combined with conventional treatment(E+C therapy)and warm needling(P<0.05).②Concerning to COPD assessment test(CAT)score,the results indicated that the Y+C therapy,and the mild moxibustion combined with conventional treatment(M+C therapy)were more effective when compared with the conventional treatment(P<0.05),and the effect of the Y+C therapy was better than that of the E+C therapy(P<0.05).③Regarding six-minute walking distance(6MWD),the effect of acupuncture combined with conventional treatment(A+C therapy)was better than that of either the E+C therapy or the conventional treatment(P<0.05).The effect of the G+C therapy was optimal for improving FEV,%,the Y+C therapy obtained the best effect for improving CAT score,and A+C therapy was the most effective for improving 6MWD.Due to the limitation of the quality and quantity of included studies,this conclusion needs to be further verified through high-quality RCT.