揿针治疗癌症相关性失眠的系统评价与Meta分析

Press Needling for Cancer-Related Insomnia: A Systematic Review and Meta-analysis

目的系统评价揿针治疗癌症相关性失眠(cancer-related insomnia,CRI)的疗效和安全性。方法从中国知网、万方数据库、重庆维普中文科技期刊数据库、中国生物医学文献数据库、PubMed、Embase和Cochrane Library电子数据库中检索自建库至2023年12月揿针治疗CRI的随机对照试验文献,由2名评价者根据纳入和排除标准纳入文献并进行数据提取,采用RevMan 5.3.0软件进行数据的整合分析。结果检索到符合纳入标准的文献6篇,共计500例患者。Meta分析结果显示,与对照组比较,揿针治疗可显著降低匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)总分[MD=-2.31,95%CI(-2.84,-1.78),P<0.00001]。同时治疗组的入睡时间、睡眠质量、睡眠时间、睡眠障碍、睡眠效率和日间功能均优于对照组;揿针治疗CRI在提高总有效率方面有优势[RR=0.38,95%CI(0.26,0.57),P<0.00001],且在每日1~3次的中频次刺激下,可通过延长疗程来提高疗效[12 d:MD=-2.17,95%CI(-3.75,-0.59);28 d:MD=-2.41,95%CI(-3.15,-1.66)];在达到或超过15 d的较长疗程治疗下,每日1~3次的中频次刺激比低于每日1次的低频次刺激疗效显著[中频次:MD=-2.41,95%CI(-3.15,-1.66);低频次:MD=-1.50,95%CI(-3.38,0.38)]。安全性方面,有2篇文献报道轻微不良反应,1篇文献报道不良反应不明,其余均未报道不良反应。结论揿针治疗可显著改善CRI患者睡眠,在提高睡眠质量方面具有优势,安全性较高。

Objective To systematically evaluate the efficacy and safety of press needling in the treatment of cancer-related insomnia(CRI).Methods We retrieved randomized controlled trials using press needles to treat CRI from China National Knowledge Infrastructure,Wanfang Data,VIP,Chinese Biomedical Literature Database,PubMed,Embase,and the Cochrane Library between database establishment and December 2023.According to the inclusion and exclusion criteria,two evaluators selected literature and extracted data.RevMan 5.3.0 software was used for data integration and analysis.Results Six articles were finally included,involving a total of 500 patients.The meta-analysis results showed that compared with the control group,press needling significantly reduced the total score of the Pittsburgh Sleep Quality Index[mean difference(MD)=-2.31,95%confidence interval(CI)(-2.84,-1.78),P<0.00001].At the same time,the treatment group had significantly better effects than the control group on sleep latency,sleep quality,sleep duration,sleep disorders,sleep efficiency,and daytime function.The press needling group was also superior with regard to the overall response rate[risk ratio=0.38,95%CI(0.26,0.57),P<0.00001].At medium frequencies of 1-3 times per day,prolonging the course of press needling treatment could significantly improve the therapeutic effect[12 days:MD=-2.17,95%CI(-3.75,-0.59);28 days:MD=-2.41,95%CI(-3.15,-1.66)].When the treatment lasted for 15 days or longer,the therapeutic outcome was significantly better with medium-frequency stimulation(1-3 times per day)than with low-frequency stimulation(<1 time per day)[medium frequency:MD=-2.41,95%CI(-3.15,-1.66);low frequency:MD=-1.50,95%CI(-3.38,0.38)].In terms of safety,two trials reported slight adverse reactions,one reported unknown adverse reactions,and the others reported none.Conclusion Press needling is a safe and effective treatment for improving the sleep of patients with CRI,especially for sleep quality.