内热针治疗腰椎间盘突出症疗效及安全性的Meta分析

A Meta-analysis of the efficacy and safety of internal heat acupun cture in the treatment of LDH

目的:系统评价内热针单独应用或联合疗法治疗腰椎间盘突出症(Lumbar Disc Herniation,LDH)的疗效和安全性。方法:用计算机检索中国知网、中国生物医学文献数据库(CBM)、维普数据库、万方数据库、Pubmed、Web of Science、Cochrance library等国内外数据库从建库至2022年12月公开发表的内热针单独应用或联合疗法治疗LDH的随机对照试验(Randomized Controlled Trials,RCTs)。由2名研究员独立进行资料提取、文献筛选,并对最终纳入的29项研究进行方法学质量评价,采用Revman 5.3软件进行统计学分析。结果:Meta分析显示,相比单独应用电针、温针、针刺、西药、腰椎牵引,或采用联合疗法(中药、腰椎牵引、其他治疗)的对照组,内热针治疗组在提高临床总有效率[相对危险度(RR)=1.20,95%置信区间(CI)[1.16,1.24],P<0.001)]、减轻疼痛[均数差(MD)=–1.58,95%CI[–1.78,–1.38],P<0.00001)]、改善腰椎功能(MD=5.45,95%CI[4.86,6.03],P<0.00001)、提高腰椎屈曲范围(MD=1.61,95%CI[1.35,1.87],P<0.00001)、降低炎性因子(肿瘤坏死因子-α、前列腺素G2)及促进β-内啡肽分泌方面优于对照组,差异具有统计学意义(P<0.05)。且未报道或提及内热针治疗过程中不良反应事件,漏斗图分析显示纳入的研究可能存在发表偏倚。结论:内热针为主治疗LDH可显著提高临床疗效、改善腰椎功能、减轻临床症状,且安全性较高,值得临床推广使用。但鉴于纳入文献质量和方法学限制,本研究结论尚需高质量、多中心、RCT研究进一步证实。

Objective:To systematically evaluate the efficacy and safety of internal heat acupuncture alone or combined therapy in the treatment of lumbar disc herniation.Methods:The studies in CNKI,CBM,VIP,Wanfang Database,Pubmed,Web of Science,Cochrance library and other domestic and foreign databases were searched by computer,and the search time was from the establishment of the databse to December 2022.Randomized controlled trials of internal heat acupuncture alone or combined therapy in the treatment of lumbar disc herniation were searched.Data extraction and literature screening were carried out independently by two researchers,and methodological quality evaluation was carried out on the 29 studies finally included,and statistical analysis was performed using Revman 5.3 software.Results:Meta-analysis showed that compared with the single treatment of electroacupuncture,warm acupuncture,acupuncture,western medicine,lumbar traction or combined therapy(traditional Chinese medicine,lumbar traction,other treatments)in the control group,the overall clinical response rate in the internal heat acupuncture group was improved(RR=1.20,95%CI[1.16,1.24],P<0.001),pain was reduced(MD=-1.58,95%CI[-1.78,-1.38],P<0.00001),and lumbar function was improved(MD=5.45,95%CI[4.86,6.03],P<0.00001),the internal heat acupuncture group were better than the control group in increased lumbar flexion range(MD=1.61,95%CI[1.35,1.87],P<0.00001),decreasing inflammatory factors(TNF-α,PEG2)and promotingβ-endorphin secretion(P<0.05).The difference was statistically significant.Adverse events during the treatment of internal heat injection were not reported or mentioned,and inverted funnel plot analysis indicated possible publication bias of the included studies.Conclusion:Internal heat acupuncture can significantly improve the clinical efficacy,promote lumbar spine function,relieve clinical symptoms,and it has high safety,which is worthy of clinical promotion.However,due to the quality and methodological limitations of the included literature,the conclusion of this review needs to be further confirmed by high-quality,multi-centre,and large-sample RCTs.