不同针刺方法治疗顽固性面瘫的贝叶斯网状meta分析

Bayesian network meta-analysis of different acupuncture methods in the treatment of intractable facial paralysis

目的采用贝叶斯网状meta分析系统评价不同针刺方法治疗顽固性面瘫的临床效果。方法检索中国生物医学文献服务系统数据库、中国知网、维普网、万方数据知识服务平台、PubMed、Embase、Cochrane Library和Web of Science中针刺方法治疗顽固性面瘫的随机对照试验,检索时限为各库建库至2024年3月。由2名研究人员独立检索、筛选文献、提取数据、纳入符合标准的文献,用Cochrane推荐的“偏倚风险评估工具”评估其偏倚风险,最后通过Stata 17.0软件对临床有效率、临床治愈率和多伦多评分等结局指标进行网状meta分析。结果最终纳入29篇随机对照试验,共计2212例患者,其中试验组1108例,对照组1104例,共涉及15种针刺疗法。浮针、毫火针+电针、埋线、埋线+电针、火针+电针、穴位注射+针刺、放血+电针、放血+针刺、温针灸+电针、小针刀+针刺、电针的临床有效率均高于针刺,埋线+电针、火针+电针、放血+电针、温针灸+电针的临床有效率均高于电针,火针+电针、放血+电针的临床有效率均高于放血+针刺,埋线+电针的临床有效率高于火针+针刺(P<0.05)。浮针、毫火针+电针、埋线、埋线+电针、火针+针刺、火针+电针、穴位注射+针刺、放血+电针、放血+针刺、温针灸+电针、电针的临床治愈率均高于针刺,放血+电针、温针灸+电针的临床治愈率均高于电针,放血+电针的临床治愈率高于放血+针刺(P<0.05)。不同干预措施患者的多伦多评分比较,差异无统计学意义(P>0.05)。提高临床有效率排名前3位的干预措施为温针灸+电针、毫火针+电针、埋线+电针;提高临床治愈率排名前3位的干预措施为温针灸+电针、放血+电针、火针+电针;改善多伦多评分排名前3位的干预措施为浮针、埋线、小针刀+针刺。临床有效率和治愈率的散点全部位于倒漏斗图内且左右分布大致对称,提示发表偏倚风险的可能性较小。结论温针灸联合电针提高临床有效率和治愈率的效果显著,浮针在改善多伦多评分方面优势明显,但仍需开展高质量临床试验予以验证。

Objective To evaluate clinical efficacy of different acupuncture methods in the treatment of intractable facial paralysis by using Bayesian network meta-analysis.Methods Randomized controlled trials of acupuncture methods in the treatment of intractable facial paralysis from databases such as China Biomedical Literature Service Ssystem,CNKI,VIP,Wanfang Data,PubMed,Embase,Cochrane Library,and Web of Science were retrieved.The search deadline was from the establishment of each database to March 2024.Two researchers independently searched,screened literature,extracted data,and included literature that met the criteria.The bias risk was evaluated by using Cochrane’s recommended“bias risk assessment tool”.Finally,network meta-analysis was conducted to analyze outcome indicators such as clinical efficacy,clinical cure rate,and Sunnybrook scores through Stata 17.0 software.Results A total of 29 randomized controlled trials were ultimately included,with total of 2212 patients,included 1108 in the experimental group and 1104 in the control group,involed total of 15 acupuncture therapies.Clinical effective rates of floating needle,millifire needle+electroacupuncture,thread embedding,thread embedding+electroacupuncture,fire needle+electroacupuncture,point injec-tion+acupuncture,bloodletting+electroacupuncture,bloodlet-ting+acupuncture,warm acupuncture and moxibustion+electr-oacupuncture,small needle knife+acupuncture,and electroacupuncture were higher than those of acupuncture,clinical effective rates of thread embedding+electroacupuncture,fire needle+electroacupuncture,bloodletting+electroacupuncture,warm acupuncture and moxibustion+electroacupuncture were higher than those of electroacupuncture,clinical efficacy rates of fire needle+electroacupuncture and bloodletting+electroacupuncture were higher than those of bloodletting+acupuncture,clinical efficacy rate of thread embedding+electroacupuncture was higher than that of fire needle+acupuncture(P<0.05).Clinical cure rates of floating needle,millifire needle+electroacupuncture,thread embedding,thread embedding+electroacupuncture,fire needle+acupuncture,fire needle+electroacupuncture,acupoint injection+acupuncture,bloodletting+electroacupuncture,bloodletting+acup uncture,warming acupuncture and moxibustion+electroacupuncture,electroa-cupuncture were higher than those of acupuncture,clinical cure rates of bloodletting+electroacupuncture,warm acupuncture and moxibustion+electroacupuncture were higher than those of electroacupuncture,clinical cure rate of bloodletting+electroacupuncture was higher than that of bloodletting+acupuncture(P<0.05).There were no statistically significant differences in Sunnybrook scores among patients with different intervention measures(P>0.05).The top three intervention measures to improve clinical effective rate were warming acupuncture and moxibustion+electroacupuncture,millifire acupuncture+electroacupuncture,thread embedding+electroacupuncture;the top three intervention measures to improve clinical cure rate were warming acupuncture and moxibustion+electroacupuncture,bloodletting+electroacupuncture and fire acupuncture+electroacupuncture;the top three intervention measures to improve Sunnybrook score were floating needle,thread embedding,small needle knife+acupuncture.The scatter plots of clinical efficacy and cure rates were all located within the funnel plot and had roughly symmetrical distribution on both sides,indicated lower likelihood of publication bias risk.Conclusion Warm acupuncture and moxibustion combined with electroacupuncture has significant effect in improving clinical efficiency and cure rate,and floating acupuncture has obvious advantages in improving Sunnybrook score,but it still needs to be verified by high-quality clinical trials.