灸法对比针刺治疗原发性痛经有效性与安全性的Meta分析

Comparison of the Effectiveness and Safety of Moxibustion and Acupuncture in the Treatment of Primary Dysmenorrhea:A Meta-analysis Study

目的:系统评价灸法对比针刺治疗原发性痛经(PD)的有效性与安全性。方法:通过计算机全面检索7个电子数据库中关于灸法对比针刺治疗PD的临床随机对照试验,检索时限为建库至2021年3月。两位研究者独立对文献进行筛选以及文献资料提取,如有分歧协商解决或由第三方仲裁解决。使用Rev Man 5.3软件进行Meta分析。结果:最终纳入7项研究,包含574例原发性痛经患者。Meta分析结果显示,在临床总有效率方面灸法治疗PD优于针刺,差异具有统计学意义[RR=4.49,95%CI(2.24,8.99),P<0.000 1]。亚组分析结果显示壮医药线点灸与针刺比较,临床疗效差异无统计学意义[RR=4.35,95%CI(0.89,21.20),P=0.07];隔物灸与针刺比较,临床疗效差异有统计学意义[RR=4.53,95%CI(2.09,9.97),P=0.000 1]。在降低VAS评分方面灸法治疗PD效果与针刺比较,差异无统计学意义[MD=-15.47,95%CI(-32.00,1.07),P=0.07]。在改善CMSS评分方面灸疗与针刺比较,差异无统计学意义[MD=-4.45,95%CI(-9.73,0.84),P=0.10]。在改善PGF2α分泌方面灸法治疗PD优于针刺[MD=-1.68,95%CI(-2.24,-1.11),P<0.000 01]。结论:灸法能有效提高临床总有效率及降低PGF2α分泌,但是由于纳入研究较少且研究质量偏低,未来需要更多高质量的随机对照试验进一步证实。

Objective:To systematically evaluate the effectiveness and safety of moxibustion compared with acupuncture in the treatment of primary dysmenorrhea(PD).Methods:A comprehensive computer search for clinical randomized controlled trials of moxibustion versus acupuncture in the treatment of primary dysmenorrhea with seven electronic databases.The search time limit was from the establishment of the database to March 2021.The two researchers independently screened the literature and extracted the literature data,and if any differences were resolved through negotiation or through a third-party arbitration.Meta analysis was performed using RevMan 5.3 software.Results:Seven studies containing 574 patients with PD were finally included.The results of meta analysis showed that moxibustion was superior to acupuncture in the total clinical effectiveness of PD,and the difference was statistically significant[RR=4.49,95%CI(2.24,8.99),P<0.0001].The results of subgroup analysis showed that there was no significant difference in clinical efficacy between Zhuang medicine thread moxibustion and acupuncture[RR=4.35,95%CI(0.89,21.20),P=0.07],compared with acupuncture,there was a statistically significant difference in clinical efficacy between spacer moxibustion and acupuncture[RR=4.53,95%CI(2.09,9.97),P=0.0001].There was no statistically significant difference in the effect of moxibustion in the treatment of PD with acupuncture in reducing the VAS score[MD=-15.47,95%CI(-32.00,1.07),P=0.07].There was no statistically significant difference between moxibustion and acupuncture in improving CMSS score[MD=-4.45,95%CI(-9.73,0.84),P=0.10].In improving the secretion of PGF2α,moxibustion was better than acupuncture in the treatment of PD[MD=-1.68,95%CI(-2.24,-1.11),P<0.00001].Conclusion:Moxibustion can effectively reduce the secretion of PGF2αand increase the total clinical effective rate.However,due to the few included studies and the low quality of the research,more high-quality randomized controlled trials are needed for further confirmation in the future.