基于网状Meta分析的针刺相关疗法治疗心力衰竭疗效评价(英文)

Acupuncture and related therapies used as add-on to conventional treatments for heart failure:A systematic review of pairwise and network meta-analyses

目的:采用网状Meta分析的方法评价针刺及其相关技术补充治疗心力衰竭的疗效。方法:检索中国知网、万方、中国生物医学数据库、PubMed、Cochrane Central及Embase数据库,检索时限为建库至2017年12月。收集已发表的在常规治疗基础上联用针刺及其相关技术治疗心力衰竭的随机对照试验,主要结局指标为纽约心功能分级及射血分数。运用Cochrane协作网推荐的偏倚风险评价工具对纳入研究进行质量评价,运用WinBUGS1.4.3和STATA 13.0软件进行数据处理及作图。结果:检索筛选后纳入符合要求的研究26篇,合计2116名患者,包含5种干预措施(针刺、艾灸、穴位贴敷、穴位注射、温针灸)。Meta分析结果显示:相比常规治疗,联合穴位按压(OR:3.28,95%CI[2.26,4.76]),针刺(OR:2.78, 95%CI[1.21, 6.41]),穴位注射(OR:3.33, 95%CI[1.85, 6.00])以及艾灸(OR:2.51, 95%CI[1.02, 6.21])均能改善患者心功能分级;联合穴位按压(MD:3.57, 95%CI[1.45, 5.70]),针刺(MD:7.75, 95%CI[2.33, 13.17]),穴位注射(MD:4.81,95%CI[2.99, 6.63])以及艾灸(MD:6.99, 95%CI[3.62, 10.36])均能提高患者射血分数。网状Meta分析结果显示:联合穴位注射对改善心功能分级效果相对最佳(SUCRA=70.0%),联合针刺对提高射血分数效果相对最佳(SUCRA=90.4%)。结论:在常规治疗基础上联合针刺及其相关技术对改善患者心功能分级、提高射血分数具有一定疗效。穴位注射对改善心功能优势较明显,针刺对提高射血分数优势较明显。但由于纳入研究数目较少、方法学质量较低,结论需进一步验证。本研究已在国际系统评价注册平台PROSPERO注册,注册号:CRD42018087700。

Objective: This study aimed to assess and compare the clinical efficacy and safety of acupuncture and related therapies(ARTs) add-on to conventional treatment(CT) for heart failure(HF) through pairwise and network meta-analyses.Methods: Six electronic databases, including PubMed, the Cochrane Central Register of Controlled Trials(CENTRAL), EMBASE, Chinese Biomedical Literature Database(CBM), China National Knowledge Infrastructure(CNKI) and Wanfang Database were searched from inceptions to December 2017. Randomized controlled trials(RCTs) regarding ARTs combining with CT for HF were eligible. The primary outcomes were changes in heart function classification(HFC) according to New York Heart Association class and left ventricular ejection fraction(LVEF). Risk of bias assessment was conducted by two independent authors.Pairwise and network meta-analyses were performed using STATA 13.0 and WinBUGS 1.4.3 software.Results: A total of 26 RCTs were enrolled for analyses, with 5 kinds of ARTs and 2116 patients in all. Pairwise meta-analyses showed that acupoint application(OR: 3.28, 95%CI[2.26, 4.76]), acupuncture(OR: 2.78, 95%CI[1.21, 6.41]), acupoint injection(OR: 3.33, 95%CI[1.85, 6.00]) and moxibustion(OR: 2.51,95%CI[1.02, 6.21]) could significantly improve HFC when they were used as add-on to CT. Acupoint application(MD: 3.57, 95%CI[ 1.45, 5.70]),acupuncture(MD: 7.75, 95%CI[2.33. 13.17]). acupoint injection(MD:4.81, 95%CI[2.99, 6.63]) and moxibustion(MD: 6.99, 95%CI[3.62, 10.36]) were significantly beneficial in improving LVEF. Network meta-analyses showed that acupoint injection(SUCRA = 70.0%) and acupuncture(SUCRA = 90.4%) respectively had the greatest probability in improving HFC and LVEF.Conclusion: Most of the included ARTs add-on to CT was effective in improving HFC and LVEF. Acupoint injection and acupuncture may respectively have better effect than others for HFC and LVEF. However,due to the small sample size and poor quality of the included studies, hence well-designed RCTs are needed to confirm our findings.This study was registered in PROSPERO, CRD42018087700.