针灸相关疗法对多囊卵巢综合征患者排卵率及妊娠率影响的网状Meta分析
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摘要
目的:系统评价针灸相关疗法对多囊卵巢综合征(PCOS)患者排卵率及妊娠率安全性和有效性的影响。方法:计算机检索PubMed、荷兰医学文献数据库(EMbase)、Cochrane图书馆(Cochrane Library)、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方(Wanfang)数据库及维普(VIP)数据库,搜集针灸治疗PCOS的随机对照试验(RCT),检索时限均为从建库至2018年1月8日。由2位研究者独立筛选文献、提取数据和评价纳入研究的偏倚风险后,采用Stata13.0和WinBUGS 1.4.3软件进行数据分析。结果:共纳入39个RCT,包括4605例PCOS患者,涉及针灸相关疗法及其综合疗法14种,均为短期疗效观察。网状Meta分析结果显示:在排卵率方面,针药联合疗法疗效优于西药,排名前6位的治疗措施分别为穴位埋线+药物联合疗法(93.3%)、艾灸+中药(91.4%)、艾灸(74.5%)、针药联合疗法(65.7%)、针灸+耳穴(61.9%)、针刺+耳穴(49.6%);在妊娠率方面,针药联合疗法疗效优于西药,排名前6位的治疗措施分别为针刺+耳穴(91.5%)、艾灸+中药(86.9%)、针灸+耳穴(81.1%)、穴位埋线+药物联合疗法(69.4%)、针药联合疗法(66.1%)、安慰剂+西药(58.7%)。结论:在针灸相关疗法中,联合疗法优于单一疗法,且安全性优于西药疗法,各类联合疗法也互有优劣。由于现有研究的局限性,本研究的结论还需大量设计合理、高质量且方法得当的RCT予以证实。
Objective To review systematically the safety and effectiveness of acupuncture-related therapies on ovulation rate and pregnancy rate in patients with polycystic ovary syndrome(PCOS). Methods From PubMed, EMbase, the Cochrane Library, China Biology Medicine disc(CBM), China National Knowledge Infrastructure(CNKI), Wanfang database and VIP database, the randomized controlled trials(RCTs) on PCOS were retrieved in the period from the date of database establishment to January 8, 2018. Two researchers screened the articles, extracted the data and assessed the bias risk of the eligible trials independently. Using Stata 13.0 and WinBUGS 1.4.3 software, the data were analyzed. Results A total of 39 RCTs were collected, including 4605 cases of PCOS and 14 kinds of acupuncture-related therapies and the comprehensive therapies. The short-term therapeutic effects were observed. The results of mesh meta-analysis showed: regarding the ovulation rate, the effects of the acupuncture-medication therapy were better than western medication. The top 6 therapeutic measures were the treatment with acupoint thread-embedding therapy and medication(93.3%), the treatment with moxibustion and Chinese herbal medicine(91.4%), moxibustion(74.5%), the treatment with acupuncture and medication(65.7%), the treatment with acupuncture-moxibustion and auricular point therapy(61.9%) and the treatment with acupuncture and auricular point therapy(49.6%). Regarding the pregnancy rate, the effects of the acupuncture-medication therapy were better than western medication. The top 6 therapeutic measures were the treatment with acupuncture and auricular point therapy(91.5%), the treatment with moxibustion and Chinese herbal medication(86.9%), the treatment with acupuncture-moxibustion and auricular point therapy(81.1%), the treatment with acupoint thread-embedding therapy and medication(69.4%), the treatment with acupuncture and medication(66.1%) and the treatment with placebo and western medication(58.7%). Conclusion Among acupuncture-related therapies, the combined treatment is more advantageous than single therapy and its safety is superior to western medication. The combined therapies are various in advantages. Because of the limitation of the present researches, it needs a large scale of RCTs with rational design, high quality and proper methods to verify this research conclusion.
Objective To review systematically the safety and effectiveness of acupuncture-related therapies on ovulation rate and pregnancy rate in patients with polycystic ovary syndrome(PCOS). Methods From PubMed, EMbase, the Cochrane Library, China Biology Medicine disc(CBM), China National Knowledge Infrastructure(CNKI), Wanfang database and VIP database, the randomized controlled trials(RCTs) on PCOS were retrieved in the period from the date of database establishment to January 8, 2018. Two researchers screened the articles, extracted the data and assessed the bias risk of the eligible trials independently. Using Stata 13.0 and WinBUGS 1.4.3 software, the data were analyzed. Results A total of 39 RCTs were collected, including 4605 cases of PCOS and 14 kinds of acupuncture-related therapies and the comprehensive therapies. The short-term therapeutic effects were observed. The results of mesh meta-analysis showed: regarding the ovulation rate, the effects of the acupuncture-medication therapy were better than western medication. The top 6 therapeutic measures were the treatment with acupoint thread-embedding therapy and medication(93.3%), the treatment with moxibustion and Chinese herbal medicine(91.4%), moxibustion(74.5%), the treatment with acupuncture and medication(65.7%), the treatment with acupuncture-moxibustion and auricular point therapy(61.9%) and the treatment with acupuncture and auricular point therapy(49.6%). Regarding the pregnancy rate, the effects of the acupuncture-medication therapy were better than western medication. The top 6 therapeutic measures were the treatment with acupuncture and auricular point therapy(91.5%), the treatment with moxibustion and Chinese herbal medication(86.9%), the treatment with acupuncture-moxibustion and auricular point therapy(81.1%), the treatment with acupoint thread-embedding therapy and medication(69.4%), the treatment with acupuncture and medication(66.1%) and the treatment with placebo and western medication(58.7%). Conclusion Among acupuncture-related therapies, the combined treatment is more advantageous than single therapy and its safety is superior to western medication. The combined therapies are various in advantages. Because of the limitation of the present researches, it needs a large scale of RCTs with rational design, high quality and proper methods to verify this research conclusion.
引文
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