针刺对原发性青光眼干预作用的Meta分析和试验序贯分析

Meta-Analysis and Sequential Analysis of Acupuncture Intervention on Primary Glaucoma

目的 系统评价针刺对原发性青光眼的干预作用。方法 检索2010年1月—2022年4月Cochrane Library、Embase、PubMed、中国知网、万方、维普、中国生物医学文献数据库,纳入针刺治疗原发性青光眼的临床随机对照试验(RCT)研究。运用Stata 14软件对总有效率、视力、眼压、视野平均光敏感度(MS)、视野平均缺损(MD)作为主要结局指标进行Meta分析,运用TSA 0.0.5.10 Beta软件进行试验序贯分析。结果 共纳入14篇文献,1,221只眼。与单纯西医治疗相比,针刺结合西医治疗原发性青光眼能够提高总有效率[OR=4.040,95%CI(2.810,5.820),Z=7.520,P=0.000]、降低眼压[WMD=-2.210,95%CI(-3.080,-1.330),Z=4.960,P=0.000]、提高视野平均光敏感度[WMD=2.610,95%CI(1.550,3.670),Z=4.820,P=0.000]、减少视野平均缺损[WMD=-2.770,95%CI(-4.070,-1.480),Z=4.200,P=0.000],差异均有统计学意义,但2组在视力改善方面差异无统计学意义(P>0.05)。试验序贯分析排除了假阳性的可能,惩罚统计量分析再次证明了针刺治疗原发性青光眼的疗效较可靠。结论 针刺治疗原发性青光眼可提高总有效率、降低眼压、提高MS、减少MD。

OBJECTIVE To systematically evaluate the intervention effect of acupuncture on primary glaucoma.METHODS Clinical randomized controlled trial(RCT)on acupuncture treatment for primary glaucoma were searched in Cochrane Library,Embase,PubMed,CNKI,Wanfang,VIP,and Chinese Biomedical Literature Database from January 2010 to April 2022.Stata 14 software was used for Meta-analysis of the main outcome measures,including overall effective rate,visual acuity,intraocular pressure,mean sensitivity(MS)of visual field,and mean defect(MD)of visual field.TSA 0.0.5.10 Beta software was used for sequential analysis.RESULTS A total of 14 articles involving 1,221 eyes were included.Compared to Western Medicine(WM)treatment alone,acupuncture combined with WM treatment for primary glaucoma was found to improve the overall effective rate[OR=4.040,95%CI(2.810,5.820),Z=7.520,P=0.000],reduce intraocular pressure[WMD=-2.210,95%CI(-3.080,-1.330),Z=4.960,P=0.000],increase MS of visual field[WMD=2.610,95%CI(1.550,3.670),Z=4.820,P=0.000],and decrease MD of visual field[WMD=-2.770,95%CI(-4.070,-1.480),Z=4.200,P=0.000].These differences were statistically significant.However,there was no statistically significant difference between the two groups in terms of visual acuity improvement(P>0.05).The sequential analysis of the experiment ruled out the possibility of false positives,and the penalty statistics analysis once again proved that the efficacy of acupuncture treatment for primary glaucoma is more reliable.CONCLUSIONS Acupuncture treatment for primary glaucoma can improve the overall effective rate,reduce intraocular pressure,increase MS,and decrease MD.