艾灸治疗原发性痛经疗效的Meta分析

Meta-analysis of Therapeutic Effect of Moxibustion on Primary Dysmenorrhea

目的:评价艾灸与药物治疗原发性痛经(PD)的临床疗效。方法:检索中国生物医学文献数据库(CBM)、国家知识基础设施数据库(CNKI)、中文科技期刊数据库(CCD)、中国学术期刊数据库(CSPD)、Pubmed、Embase、Cochrane Library等数据库,收集自建库至2021年4月10日艾灸对比药物干预治疗PD的随机对照试验(RCT),采用Jadad评分量表对文献质量进行评价,使用Cochrane偏倚风险评估工具进行质量评估。通过Rev Man5.4和Stata 15软件进行Meta分析。结果:共纳入16篇RCT文献,文献在盲法的实施上存在高风险,随机化分配与隐藏方案不详。Meta分析结果显示,艾灸组总有效率与药物组比较,差异有统计学意义(RR=1.25,95%CI为1.19~1.31,P<0.00001)。漏斗图左右不对称,提示可能存在发表偏倚。艾灸组治愈率与药物组比较,差异有统计学意义(RR=2.45,95%CI为2.00~3.01,Z=8.56,P<0.00001)。2组在痛经症状积分、视觉模拟评分法(VAS)疼痛评分改善方面存在异质性,差异有统计学意义(P=0.00001)。结论:艾灸治疗PD疗效明显优于药物组,但由于纳入随机对照试验的数量较少且质量参差,仍需要大样本、多中心、高质量的RCT评估其安全性和有效性。

Objective:To evaluate the clinical efficacy of moxibustion and drug therapies in treating primary dysmenorrhea(PD).Methods:The randomized controlled trials(RCTs)of moxibustion versus drug therapies for PD were retrieved from the China Biology Medicine(CBM),China National Knowledge Infrastructure(CNKI),Chinese Citation Database(CCD),China Science Periodical Database(CSPD),PubMed,Embase,and Cochrane Library with the time interval from inception to April 10,2021.The Jadad scale was employed to evaluate the included articles,and the Cochrane′s risk of bias assessment tool to evaluate the risk of bias.The meta-analysis was performed in Rev Man5.4 and Stata 15.Results:A total of 16 RCTs were included.There was a high risk in the implementation of the blind method,and the randomization and concealment schemes were unknown.The results of meta-analysis showed that the total response rate differed between the moxibustion group and the drug group(RR=1.25,95%CI of 1.19 to 1.31,P<0.00001).The left and right side of the funnel plot were not symmetrical,suggesting that there may be publication bias.The cure rate differed between the moxibustion group and the drug group(RR=2.45,95%CI of 2.00 to 3.01,Z=8.56,P<0.00001).The changes in the dysmenorrhea symptom score and visual analogue scale score also differed between the two groups(P=0.00001).Conclusion:Moxibustion had better efficacy than drugs in the treatment of PD.However,due to the small number and low quality of the included RCTs,large-sample,multi-center,and high-quality RCTs are needed to evaluate the safety and efficacy of moxibustion.