穴位埋线治疗慢性荨麻疹疗效与安全性的系统评价
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摘要
【目的】系统评价穴位埋线治疗慢性荨麻疹的疗效与安全性。【方法】计算机全面检索Cochrane Library、PubMed、Embase、万方(Wanfang)、维普(VIP)、中国学术期刊全文数据库(CNKI)和中国生物医学文献数据库(CBM),检索时限均从建库至2017年8月,查找穴位埋线治疗慢性荨麻疹的随机对照试验(RCTs)。由2名研究者独立进行筛选、数据提取和质量评价后,采用RevMan 5.2软件对数据进行统计学分析。【结果】纳入的12个RCTs,共836例慢性荨麻疹患者。Meta分析结果显示:穴位埋线治疗慢性荨麻疹的有效率优于其他疗法[RR=1.10,95%CI(1.03,1.16),P=0.002];穴位埋线治疗慢性荨麻疹的治愈率优于其他疗法[RR=1.59,95%CI(1.30,1.95),P<0.000 05];穴位埋线组的复发率低于常规治疗组[RR=0.49,95%CI(0.27,0.86),P=0.01];描述性分析显示穴位埋线组较常规疗法组有更少的不良反应。【结论】与常规抗组胺药和常规针灸及中药相比,穴位埋线有更好的治愈率和有效率,且对降低复发率起到一定的作用。但由于纳入的研究存在较大的偏倚风险,证据强度较低,当前的证据尚不能完全用于临床,其疗效优势和安全性仍需要通过开展更多高质量多中心大样本随机对照试验来验证。
Objective To systematically evaluate the effectiveness and safety of acupoint catgut-embedding for the treatment of chronic urticaria(CU). Methods We searched the Cochrane Library,PubMed,Embase,Wanfang data library,VIP Database,China National Knowledge Infrastructure(CNKI)and China Biology Medicine disc(CBM)to collect the randomized controlled trials(RCTs)of acupoint catgut-embedding for the treatment of CU from data beginning to August 2017. According to the inclusion and exclusion criteria,the literature screening,data extraction,and quality assessment were performed by 2 researchers independently,the data were statistically analyzed by RevMan 5.2. Results A total of 12 RCTs involving 836 patients were enrolled. The results of Meta-analysis showed that the effective rate of acupoint catgut-embedding in treating CU was superior to that of other therapies [RR=1.10, 95% CI(1.03, 1.16), P = 0.002], and the cure rate of acupoint catgut-embedding in treating CU was superior to that of other therapies [RR=1.59, 95% CI(1.30, 1.95), P<0.000 05]. The recurrence rate of acupoint catgut-embedding group was lower than that of the conventional therapy group [RR =0.49, 95% CI(0.27, 0.86), P = 0.01]. The descriptive analysis results showed that the acupoint catgut-embedding group had fewer adverse effects than the conventional therapy group. Conclusion Compared with the conventional antihistamines,routine acupuncture and traditional Chinese medicine,acupoint catgut-embedding has better cure rate and clinical efficiency in the treatment of CU, and plays a certain role in reducing the recurrence rate. However,due to the high risk of bias in the included studies,the evidence reliability is relatively low,and the current evidence cannot be fully used in clinical practice,so its efficacy advantage and safety still need to be verified by more high-quality multi-center large-scale RCTs.
Objective To systematically evaluate the effectiveness and safety of acupoint catgut-embedding for the treatment of chronic urticaria(CU). Methods We searched the Cochrane Library,PubMed,Embase,Wanfang data library,VIP Database,China National Knowledge Infrastructure(CNKI)and China Biology Medicine disc(CBM)to collect the randomized controlled trials(RCTs)of acupoint catgut-embedding for the treatment of CU from data beginning to August 2017. According to the inclusion and exclusion criteria,the literature screening,data extraction,and quality assessment were performed by 2 researchers independently,the data were statistically analyzed by RevMan 5.2. Results A total of 12 RCTs involving 836 patients were enrolled. The results of Meta-analysis showed that the effective rate of acupoint catgut-embedding in treating CU was superior to that of other therapies [RR=1.10, 95% CI(1.03, 1.16), P = 0.002], and the cure rate of acupoint catgut-embedding in treating CU was superior to that of other therapies [RR=1.59, 95% CI(1.30, 1.95), P<0.000 05]. The recurrence rate of acupoint catgut-embedding group was lower than that of the conventional therapy group [RR =0.49, 95% CI(0.27, 0.86), P = 0.01]. The descriptive analysis results showed that the acupoint catgut-embedding group had fewer adverse effects than the conventional therapy group. Conclusion Compared with the conventional antihistamines,routine acupuncture and traditional Chinese medicine,acupoint catgut-embedding has better cure rate and clinical efficiency in the treatment of CU, and plays a certain role in reducing the recurrence rate. However,due to the high risk of bias in the included studies,the evidence reliability is relatively low,and the current evidence cannot be fully used in clinical practice,so its efficacy advantage and safety still need to be verified by more high-quality multi-center large-scale RCTs.
引文
[1]中华医学会皮肤性病学分会免疫学组.中国荨麻疹诊疗指南(2014版)[J].中华皮肤科杂志,2014,47(7):514.
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[8]林文霞,申婕,孙虹.穴位埋线在慢性荨麻疹治疗中的应用[J].云南中医中药杂志,2017,38(1):95.
[9]李静,李幼平.不断完善与发展的Cochrane系统评价[J].中国循证医学杂志,2008,8(9):742.
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[12]杨新利,贾庆岭,刘彭华,等.穴位埋线联合药物治疗幽门螺旋杆菌感染所致慢性荨麻疹[J].中国针灸,2010,30(12):993.
[13]杨才德,龚旺梅,包金莲,等.“三风穴”(风门、风市、风市前)为主埋线治疗慢性荨麻疹的疗效及其作用机理研究[J].中国地方病防治杂志,2014,29(Z2):84.
[14]卫哲,杨才德,马重兵,等.中国穴位埋线疗法系列讲座(二十七)“三风穴”为主穴位埋线对慢性荨麻疹患者血清IFN-γ的影响[J].中国中医药现代远程教育,2016,14(10):106.
[15]盘文丽.穴位埋线法治疗胃肠湿热型慢性荨麻疹的临床研究[D].昆明:云南中医学院,2016.
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[17]刘俐伶,王宪灵,麻继臣,等.穴位埋线与盐酸西替利嗪治疗慢性荨麻疹的疗效比较及对血清IgE的影响[J].河北医药,2013,35(3):458.
[18]黄艳霞.穴位埋线配合祛风消荨汤治疗慢性荨麻疹疗效观察[J].按摩与康复医学,2015,6(4):23.
[19]胡剑白,刘俊波,游永强.穴位埋线对慢性荨麻疹患者血清IL-4、IFN-γ和IgE的影响[J].现代医院,2016,16(5):691.
[20]邓玉玲,温莹浩.养血消风汤配合穴位埋线治疗顽固性荨麻疹的临床研究[J].中国医学创新,2012,9(32):18.
[21]程孝顶,路永红,吴波,等.穴位埋线治疗慢性荨麻疹56例临床观察[J].中医药导报,2012,18(9):64.
[22]任建军.GLPA线体微创埋线治疗慢性荨麻疹临床观察[C].第十一届苏南苏中地区针灸学术交流大会论文集,2012:129.
[23]张世洪.Meta分析应合理设置亚组分析与敏感性分析以准确解释结果[J].中国现代神经疾病杂志,2016,16(1):1.
[24]宋黎,叶俊儒,陆茂,等.成都地区859例慢性荨麻疹患者过敏原检测结果分析[J].重庆医学,2016,45(7):918.
[25]时素华,孙爱军,王丽,等.穴位埋线疗法临床研究文献评价[J].广州中医药大学学报,2010,27(1):78.
[2]宋志强.慢性荨麻疹的临床分型、定义、特征及其分型的意义[J].皮肤病与性病,2015,37(1):14.
[3]Maurer M,Ortonne J P,Zuberbier T.Chronic urticaria:an internet survey of health behaviours symptom patterns and treatment needs in European adult patients[J].Br J Dermatol,2009,160(3):633.
[4]Zubrbier T,Aberer W,Asero R,et al.The EAACI GA2 LENEDF WAO Guidline for the definition,classification,diagnosis,and management of urticaria:the 2013 revision and update[J].Allergy,2014,69(7):868.
[5]Maurer K,Weller C,Bindslev J,et al.Unmet clinical needs in chronic spontaneous urticaria A GA2LEN task force report[J].Allergy,2011,66(3):317.
[6]温木生.试论穴位埋线疗法的综合性效应及治疗机理[J].陕西中医学院学报,1993,16(2):6.
[7]李知行,张海华,李素荷.李素荷穴位埋线治疗支气管哮喘经验[J].广州中医药大学学报,2015,32(3):533.
[8]林文霞,申婕,孙虹.穴位埋线在慢性荨麻疹治疗中的应用[J].云南中医中药杂志,2017,38(1):95.
[9]李静,李幼平.不断完善与发展的Cochrane系统评价[J].中国循证医学杂志,2008,8(9):742.
[10]Julian P T H,Simon G T,Jonathan J D,et al.Measuring inconsistency in meta-analyses[J].British medical journal,2003,327(7414):557.
[11]张玉红,边胜男,赵会亮.咪唑斯汀联合穴位埋线治疗慢性自发性荨麻疹疗效观察[J].中国中西医结合皮肤性病学杂志,2013,12(1):51.
[12]杨新利,贾庆岭,刘彭华,等.穴位埋线联合药物治疗幽门螺旋杆菌感染所致慢性荨麻疹[J].中国针灸,2010,30(12):993.
[13]杨才德,龚旺梅,包金莲,等.“三风穴”(风门、风市、风市前)为主埋线治疗慢性荨麻疹的疗效及其作用机理研究[J].中国地方病防治杂志,2014,29(Z2):84.
[14]卫哲,杨才德,马重兵,等.中国穴位埋线疗法系列讲座(二十七)“三风穴”为主穴位埋线对慢性荨麻疹患者血清IFN-γ的影响[J].中国中医药现代远程教育,2016,14(10):106.
[15]盘文丽.穴位埋线法治疗胃肠湿热型慢性荨麻疹的临床研究[D].昆明:云南中医学院,2016.
[16]刘雪青.穴位埋线治疗慢性荨麻疹疗效观察[J].内蒙古中医药,2013,32(34):70.
[17]刘俐伶,王宪灵,麻继臣,等.穴位埋线与盐酸西替利嗪治疗慢性荨麻疹的疗效比较及对血清IgE的影响[J].河北医药,2013,35(3):458.
[18]黄艳霞.穴位埋线配合祛风消荨汤治疗慢性荨麻疹疗效观察[J].按摩与康复医学,2015,6(4):23.
[19]胡剑白,刘俊波,游永强.穴位埋线对慢性荨麻疹患者血清IL-4、IFN-γ和IgE的影响[J].现代医院,2016,16(5):691.
[20]邓玉玲,温莹浩.养血消风汤配合穴位埋线治疗顽固性荨麻疹的临床研究[J].中国医学创新,2012,9(32):18.
[21]程孝顶,路永红,吴波,等.穴位埋线治疗慢性荨麻疹56例临床观察[J].中医药导报,2012,18(9):64.
[22]任建军.GLPA线体微创埋线治疗慢性荨麻疹临床观察[C].第十一届苏南苏中地区针灸学术交流大会论文集,2012:129.
[23]张世洪.Meta分析应合理设置亚组分析与敏感性分析以准确解释结果[J].中国现代神经疾病杂志,2016,16(1):1.
[24]宋黎,叶俊儒,陆茂,等.成都地区859例慢性荨麻疹患者过敏原检测结果分析[J].重庆医学,2016,45(7):918.
[25]时素华,孙爱军,王丽,等.穴位埋线疗法临床研究文献评价[J].广州中医药大学学报,2010,27(1):78.