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.
引文
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