针灸治疗盆腔炎性疾病后遗症-慢性盆腔痛有效性与安全性的Meta分析

A Meta-analysis of Efficacy and Safety of Acupuncture in Treatment of Chronic Pelvic Pain with Sequelae of Pelvic Inflammatory Disease

目的系统评价针灸治疗盆腔炎性疾病后遗症-慢性盆腔痛(SPID-CPP)的临床疗效和安全性。方法计算机检索中国知网、维普数据库、万方数据库、PubMed、Cochrane Library、Embase数据库中非针灸疗法基础上联用针灸疗法治疗SPID-CPP的随机对照试验,检索时间为建库至2021年10月。根据文献纳入与排除标准,将最终纳入的文献进行数据提取,使用Cochrane偏倚风险评估工具进行风险分析,采用RevMan 5.4软件进行Meta分析,Stata 15.0软件进行发表偏倚检验。结果最终纳入文献19篇,研究对象总计1701例。Meta分析结果显示,试验组(采用针灸疗法结合非针灸疗法)治疗后总有效率显著高于对照组(采用非针灸疗法)(OR=3.94,95%CI 2.82~5.52,P<0.00001);联用针刺组和联用电针组改善视觉模拟评分法评分的疗效均显著优于无针灸疗法对照组(MD=-2.08,95%CI-2.54~-1.63,P<0.00001;MD=-0.93,95%CI-1.58~-0.29,P=0.005);3个月至半年后随访和1年后随访时,试验组总有效率均显著高于对照组(OR=4.95,95%CI 2.22~11.02,P<0.0001;OR=6.68,95%CI 2.33~19.18,P=0.0004)。对照组与试验组不良反应发生率比较差异无统计学意义(OR=1.30,95%CI 0.40~4.29,P=0.66)。结论非针灸疗法基础上联用针灸疗法治疗SPID-CPP可以提高近、远期疗效和镇痛效果,且不会增加不良事件发生率。

Objective To systematically evaluate the clinical efficacy and safety of acupuncture in the treatment of sequelae of pelvic inflammatory disease-chronic pelvic pain(SPID-CPP).Methods CNKI,VIP,Wanfang,PubMed,Cochrane Library and Embase databases were searched by computer to collect randomized controlled trials on all non-acupuncture therapy combined with acupuncture therapy for SPID-CPP from the time of establishment through to Oct.2021.According to the inclusion and exclusion criteria of literature,data were extracted from the included literature.Cochrane bias risk assessment tool was used for risk analysis.RevMan 5.4 software was used for meta-analysis,Stata 15.0 software was used for publication bias test.Results Nineteen articles were included,with 1701 subjects in total.The results of meta-analysis showed that the total effective rate of the test group(combination of acupuncture and non-acupuncture therapy)was significantly higher than that of the control group(non-acupuncture therapy)(OR=3.94,95%CI 2.82-5.52,P<0.00001).The efficacy of the combined acupuncture group and the combined electroacupuncture group in improving visual analogue scale score was significantly better than that of the control group without acupuncture therapy(MD=-2.08,95%CI-2.54--1.63,P<0.00001;MD=-0.93,95%CI-1.58--0.29,P=0.005);at follow-up of 3 months to 6 months and 1 year,the total effective rate of the test group was significantly higher than that of the control group(OR=4.95,95%CI 2.22-11.02,P<0.0001;OR=6.68,95%CI 2.33-19.18,P=0.0004).There was no significant difference in the incidence of adverse reactions between the control group and the test group(OR=1.30,95%CI 0.40-4.29,P=0.66).Conclusion Acupuncture combined with non-acupuncture therapy in the treatment of SPID-CPP can improve the near-term and long-term efficacy and analgesic effect without increasing the incidence of adverse events.