指针疗法治疗胃食管反流病的Meta分析
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摘要
目的:系统评价指针疗法对胃食管反流病的临床疗效及安全性。方法:采用Cochrane系统评价方法,计算机检索Pubmed、CNKI、CBM、万方、维普数据库,检索从建库至2018年2月,收集指针疗法(或联合内服药物)治疗胃食管反流病(GERD)的随机、半随机对照试验,由2位评价员对符合纳入标准的临床实验研究进行质量评价和资料提取,采用Revman 5. 3. 0软件对结果进行Meta分析。结果:共纳入文献11篇,1163例患者。Meta分析结果显示,指针疗法组(或联合内服药物)与对照组(内服药物)相比,在8项研究中的总有效率(RR=1. 17,95%CI 1. 11～1. 24,P <0. 00001)及在4项研究中的不良反应(RR=0. 16,95%CI 0. 04～0. 60,P=0. 007)方面均优于对照组(内服药物),且显著减少食管酸反流。但在提高食管括约肌压力方面,两组无显著性差异(P> 0. 05)。结论:分析结果显示,指针疗法是治疗胃食管反流病的有效且安全手段,但受纳入研究的数量及质量的限制,该结论仍需更严谨的大规模多中心临床试验以进一步验证。
Objective: To systematically review the clinical therapeutic effects and safety of gastroesophageal reflux disease( GERD) treated with the acupoint pointer therapy of TCM. Methods: The Cochrane systematic review method was adopted to retrieve Pub Med,CNKI,CBM,VIP and Wanfang Data( from their inception to February 2018) for randomized controlled trials( RCTs) or semi-RCTs of GERD treated with TCM acupoint pointer therapy( or combined with medication) were collected. After the quality evaluation and data extraction,the clinical studies according with inclusive criteria were performed the Meta-analysis by Rev Man 5. 3. 0 software. Results: Eleven RCTs involving 1163 were ultimately identified. The results of Meta-analyses showed that compared with control group( medicinal therapy),the experimental group( acupoint pointer therapy/or combined with medication) for GERD symptom was more significant( RR = 1. 17,95% CI =( 1. 11,1. 24),P < 0. 00001) on eight RCTs studies. Four RCTs studies reported the adverse effects in the course of treatment. Meta-analysis showed that the experimental group was better than the control group( RR = 0. 16,95% = CI( 0. 04,0. 60),P = 0. 007) and reduced esophageal acid reflux while both groups in improving esophageal sphincter pressure were similar( both P > 0. 05). Conclusion: This Meta-analysis suggests that acupoint pointer therapy is an effective and safe treatment for GERD. However,due to the small sample size and poor methodological quality of the included trials,a more rigorous design of large scale and multiple center studies are required to validate those conclusions.
Objective: To systematically review the clinical therapeutic effects and safety of gastroesophageal reflux disease( GERD) treated with the acupoint pointer therapy of TCM. Methods: The Cochrane systematic review method was adopted to retrieve Pub Med,CNKI,CBM,VIP and Wanfang Data( from their inception to February 2018) for randomized controlled trials( RCTs) or semi-RCTs of GERD treated with TCM acupoint pointer therapy( or combined with medication) were collected. After the quality evaluation and data extraction,the clinical studies according with inclusive criteria were performed the Meta-analysis by Rev Man 5. 3. 0 software. Results: Eleven RCTs involving 1163 were ultimately identified. The results of Meta-analyses showed that compared with control group( medicinal therapy),the experimental group( acupoint pointer therapy/or combined with medication) for GERD symptom was more significant( RR = 1. 17,95% CI =( 1. 11,1. 24),P < 0. 00001) on eight RCTs studies. Four RCTs studies reported the adverse effects in the course of treatment. Meta-analysis showed that the experimental group was better than the control group( RR = 0. 16,95% = CI( 0. 04,0. 60),P = 0. 007) and reduced esophageal acid reflux while both groups in improving esophageal sphincter pressure were similar( both P > 0. 05). Conclusion: This Meta-analysis suggests that acupoint pointer therapy is an effective and safe treatment for GERD. However,due to the small sample size and poor methodological quality of the included trials,a more rigorous design of large scale and multiple center studies are required to validate those conclusions.
引文
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[11]梁尧,李洁.指针疗法治疗反流性食管炎疗效观察[J].广西中医药,2010,33(1):27-28.
[12]蒋守忠.药穴指针疗法治疗60例胃食管反流病的疗效观察[J].中国当代医药,2012,19(17):93,96.
[13]朱初良,谢胜,周晓玲,等.中药联合背俞指针疗法治疗胃食管反流病伴抑郁患者40例[J].湖南中医杂志,2013,29(7):43-44.
[14]宁庆云,谢胜,周晓玲,等.仲景桂枝人参汤联合背俞指针疗法治疗虚寒型胃食管反流病30例[J].辽宁中医杂志,2013,40(9):1861-1863.
[15]谢胜,欧阳波,韦金秀,等.背俞指针疗法对胃食管反流病患者酸反流与食管下括约肌压力的影响[J].中国中医药信息杂志,2014,21(12):19-21.
[16]刘嵩,石拓,杨家耀.指针疗法联合埃索美拉唑、莫沙比利治疗胃食管反流病食管外症状疗效观察[J].中国中西医结合消化杂志,2015,23(4):288-290.
[17]李洁,严光俊,聂学.药穴指针疗法治疗胃食管反流病的临床观察[J].内蒙古中医药,2016,35(7):70.
[18]司勤,周银秀.药穴指压疗法在治疗156例胃食管反流病中的作用[J].中国中西医结合消化杂志,2017,25(8):629-630.
[19]李洁,司勤,严光俊,等.药穴指针疗法治疗中虚气逆型胃食管反流病的临床观察[J].中医临床研究,2017,9(3):83-85.
[20]谢胜.国家中医药管理局农村中医适宜技术推广专栏(112)药穴指针疗法治疗胃食管反流病技术[J].中国乡村医药,2016,23(13):86-87.
[2]El-Serag HB,Sweet S,Winchester CC,et al. Update on the epidemiology of gastro-oesophageal reflux disease:a systematic review[J].Gut,2014,63(6):871-880.
[3]李爽,周康年,侯立新,等.上海宝山地区胃食管反流病流行学研究及生活质量评价[J].临床消化病杂志,2015,27(6):333-336.
[4]王河,汪安江,朱萱王.胃食管反流病药物治疗进展[J].世界华人消化杂志,2011,19(16):1711-1719.
[5]Wagner JS,Di Bonaventura MD,Balu S,et al. The burden of diurnal and nocturnal gastroesophageal reflux disease symptoms[J]. Expert Rev Pharmacoecon Outcomes Res,2011,11(6):739-749.
[6]Zhu J,Guo Y,Liu S,et al. Acupuncture for the treatment of gastrooesophageal reflux disease:a systematic review and meta-analysis[J]. Acupunct Med,2017,35(5):316-323.
[7]谢胜,梁健,颜春艳,等.药穴指针疗法治疗胃食管反流病的疗效观察[J].中国中西医结合杂志,2007,27(4):355-358.
[8]林三仁,许国铭,胡品津,等.中国胃食管反流病共识意见[J].胃肠病学,2007,12(4):233-239.
[9]Fock KM,Talley N,Goh KL,et al. Asia-Pacific consensus on the management of gastro-oesophageal reflux disease:an update focusing on refractory reflux disease and Barrett's oesophagus[J]. Gut,2016,65(9):1402-1415.
[10]谢胜,颜春艳,张云波.药穴指针疗法合温胆汤治胃热型胃食管反流病40例[J].江西中医药,2008,39(10):66-67.
[11]梁尧,李洁.指针疗法治疗反流性食管炎疗效观察[J].广西中医药,2010,33(1):27-28.
[12]蒋守忠.药穴指针疗法治疗60例胃食管反流病的疗效观察[J].中国当代医药,2012,19(17):93,96.
[13]朱初良,谢胜,周晓玲,等.中药联合背俞指针疗法治疗胃食管反流病伴抑郁患者40例[J].湖南中医杂志,2013,29(7):43-44.
[14]宁庆云,谢胜,周晓玲,等.仲景桂枝人参汤联合背俞指针疗法治疗虚寒型胃食管反流病30例[J].辽宁中医杂志,2013,40(9):1861-1863.
[15]谢胜,欧阳波,韦金秀,等.背俞指针疗法对胃食管反流病患者酸反流与食管下括约肌压力的影响[J].中国中医药信息杂志,2014,21(12):19-21.
[16]刘嵩,石拓,杨家耀.指针疗法联合埃索美拉唑、莫沙比利治疗胃食管反流病食管外症状疗效观察[J].中国中西医结合消化杂志,2015,23(4):288-290.
[17]李洁,严光俊,聂学.药穴指针疗法治疗胃食管反流病的临床观察[J].内蒙古中医药,2016,35(7):70.
[18]司勤,周银秀.药穴指压疗法在治疗156例胃食管反流病中的作用[J].中国中西医结合消化杂志,2017,25(8):629-630.
[19]李洁,司勤,严光俊,等.药穴指针疗法治疗中虚气逆型胃食管反流病的临床观察[J].中医临床研究,2017,9(3):83-85.
[20]谢胜.国家中医药管理局农村中医适宜技术推广专栏(112)药穴指针疗法治疗胃食管反流病技术[J].中国乡村医药,2016,23(13):86-87.