针刺治疗过敏性鼻炎随机对照试验的系统综述与Meta分析

Systematic Review and Meta Analysis of the Randomized Controlled Trial of Acupuncture for Allergic Rhinitis

目的运用循证医学系统综述方法评价针刺治疗过敏性鼻炎(AR)的疗效及安全性。方法检索CNKI、VIP、Wanfang、Pub Med和Cochrane Library数据库,对未发表的相关会议论文、学位论文进行追溯,并补充检索文献、论文综述部分的参考文献。时间截止至2015年11月。收集单纯针刺或针刺联合相关辅助疗法/阳性药物对比阳性药物(或假针刺/空白对照/安慰剂)治疗AR的随机对照试验。合并临床异质性较小的文献使用Rev Man5.2进行Meta分析,否则进行定性分析。结果纳入文献30篇,共2602例AR患者,共合并3组11篇文献进行Meta分析,结果显示:单纯针刺组有效率明显高于西药组;针刺联合电针组有效率明显高于西药组;单纯针刺组有效率明显高于假针刺组。定性分析结果显示:以针刺为基础疗法(或联合其他辅助疗法)在改善AR患者鼻部症状有效率方面优于或等于对照组疗效。局限性:因语言限制只纳入中文及英文文献可能造成文献检索中的选择偏倚;因阳性结果更易于发表可能使纳入的文献存在潜在发表偏倚。结论针刺或针刺联合电针等相关辅助疗法对于AR患者鼻部症状的改善存在一定疗效;针刺或针刺联合电针等相关辅助疗法对AR患者鼻部症状的改善可能存在一定的远期疗效;针刺的安全性目前尚无法得出确切评价。

Objective To evaluate the efficacy and safety of acupuncture for allergic rhinitis( AR)with the systematic review of evidence- based medicine. Methods The database of CNKI,VIP,Wanfang,Pubmed and Cochrane Library were retrieved. The relevant and unpublished conference paper and academic dissertation were traced. Additionally,the references of retrieved literatures and the reviews of paper were supplemented. The deadline time of retrieval was November 2015. The randomized controlled trials( RCTs) of AR were collected in terms of the treatments with simple acupuncture or combined therapy of acupuncture and relevant adjuvant treatment / control positive medication( or sham- acupuncture / blank control / placebo).Rev Man5. 2 was used for the combination of the literatures with low clinical heterogeneity for the Meta- analysis. Otherwise,the qualitative analysis was followed. Results The effective rate in the simple acupuncture group was apparently higher than that in the western medicine group,that in the combined group of acupuncture and electroacupuncture was apparently higher than that in the western medicine group,and that in the simple acupuncture group was apparently higher than that in the sham- acupuncture group. The results of quantitative analysis showed: for the improvement of the effective rate of AR symptoms treated with basic therapy of acupuncture( or combined with other adjuvant treatment),the results were better than or equal to those in the control group. Limitation: due to the language issue,the literatures of Chinese and English version were included,which possibly induced selection bias. The results for the positive results were easily published,which could induce the potential publication bias of the included literatures. Conclusion Acupuncture or the adjuvant therapy with electric stimulation combined has a certain efficacy on the symptoms of AR and displays the long- term efficacy. The safety of acupuncture has not been evaluated definitely at present yet.