Acupuncture for treatment of irritable bowel syndrome.
Acupuncture for treatment of irritable bowel syndrome.
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DOI：
10.1002/14651858.cd005111.pub2
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发表时间：
2006
期刊：
影响因子：
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通讯作者：
Byungmook Lim;E. Manheimer;L. Lao;E. Ziea;J. Wisniewski;Jianpin Liu;B. Berman
中科院分区：
文献类型：
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作者：
Byungmook Lim;E. Manheimer;L. Lao;E. Ziea;J. Wisniewski;Jianpin Liu;B. Berman
肠易激综合征（IBS）是一种与腹痛或不适相关的排便习惯改变的疾病。IBS引起的疼痛、不适和损伤通常导致医疗咨询（塔利1997）和工作场所缺勤，以及相关的经济成本（Leong 2003）。最近的一项随机对照试验显示了不同的结果，但没有明确的证据支持针灸作为IBS的有效治疗（Fireman 2001）。本系统综述的目的是确定针灸是否比不治疗更有效，比“假”（安慰剂）针灸更有效，以及与其他用于治疗肠易激综合征的干预措施一样有效。与针灸相关的不良事件也进行了评估。检索策略：检索以下电子书目数据库，不考虑语言、出版日期和出版状态：MEDLINE、科克伦图书馆的科克伦对照试验中心注册库（CENTRAL）、EMBASE、中国生物医学数据库、护理和相关健康累积索引（CINAHL）和相关和补充医学数据库（AMED）。手工筛选相关综述和RCT中的参考文献。研究检索的最后日期为2006年2月7日。选择标准已发表的关于针刺治疗IBS的随机对照试验（RCT）和半随机试验的报告。数据收集和分析对识别出的所有合格记录进行双重合格性评价和双重摘要。使用Jadad量表和Linde内部效度量表评估方法学质量。当干预措施足够相似时，将单个试验的数据合并进行荟萃分析。使用I平方统计量评估异质性。主要结果纳入6个试验。通过整体症状评分或患者确定的治疗成功率评估的应答者比例，在针灸组和假针灸组之间没有显示出显著差异，合并相对风险为1.28（95%CI 0.83至1.98; n=109）。针灸治疗在总体健康、个体症状（例如，腹痛、排便困难、腹泻和腹胀）、由盲法临床医生评估的改善的患者数量或EuroQol评分。在没有假对照的两项研究中，针灸在改善症状方面比对照治疗更有效：针灸与草药治疗的RR为1.14（95% CI 1.00至1.31; n=132）;针灸加心理治疗与单独心理治疗的RR为1.20（95% CI 1.03至1.39; n=100）。当耳针治疗的效果与地西泮、奋乃静或多潘立酮中一种或多种药物的不明确组合进行比较时，差异无统计学意义，RR为1.49（95%CI 0.94至2.34; n=48）。专家结论：本综述中的大多数试验质量较差，在干预、对照和测量的结果方面存在异质性。除了两项试验之间有一个共同的结局外，未合并数据。因此，针灸治疗IBS是否比假针灸或其他干预措施更有效仍无定论。
BACKGROUND Irritable bowel syndrome (IBS), a disorder of altered bowel habits associated with abdominal pain or discomfort. The pain, discomfort, and impairment from IBS often lead to healthcare medical consultation (Talley 1997) and workplace absenteeism, and associated economic costs (Leong 2003). A recent randomized controlled trial shows variable results but no clear evidence in support of acupuncture as an effective treatment for IBS (Fireman 2001). OBJECTIVES The objective of this systematic review is to determine whether acupuncture is more effective than no treatment, more effective than 'sham' (placebo) acupuncture, and as effective as other interventions used to treat irritable bowel syndrome. Adverse events associated with acupuncture were also assessed. SEARCH STRATEGY The following electronic bibliographic databases were searched irrespective of language, date of publication, and publication status: MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, EMBASE, the Chinese Biomedical Database, the Cumulative Index to Nursing and Allied Health (CINAHL), and the Allied and Complementary Medicine Database (AMED). References in relevant reviews and RCTs were screened by hand. The last date for searching for studies was 7 February 2006. SELECTION CRITERIA Published reports of randomized controlled trials (RCTs) and quasi-randomised trials of acupuncture therapy for IBS. DATA COLLECTION AND ANALYSIS All eligible records identified were dually evaluated for eligibility and dually abstracted. Methodological quality was assessed using the Jadad scale and the Linde Internal Validity Scale. Data from individual trials were combined for meta-analysis when the interventions were sufficiently similar. Heterogeneity was assessed using the I squared statistic. MAIN RESULTS Six trials were included. The proportion of responders, as assessed by either the global symptom score or the patient-determined treatment success rate, did not show a significant difference between the acupuncture and the sham acupuncture group with a pooled relative risk of 1.28 (95% CI 0.83 to 1.98; n=109). Acupuncture treatment was also not significantly more effective than sham acupuncture for overall general well-being, individual symptoms (e.g., abdominal pain, defecation difficulties, diarrhea, and bloating), the number of improved patients assessed by blinded clinician, or the EuroQol score. For two of the studies without a sham control, acupuncture was more effective than control treatment for the improvement of symptoms: acupuncture versus herbal medication with a RR of 1.14(95% CI 1.00 to 1.31; n=132); acupuncture plus psychotherapy versus psychotherapy alone with a RR of 1.20 (95% CI 1.03 to 1.39; n=100). When the effect of ear acupuncture treatment was compared to an unclearly specified combination of one or more of the drugs diazepam, perphenazine or domperidone, the difference was not statistically significant with a RR of 1.49(95% CI 0.94 to 2.34; n=48). AUTHORS' CONCLUSIONS Most of the trials included in this review were of poor quality and were heterogeneous in terms of interventions, controls, and outcomes measured. With the exception of one outcome in common between two trials, data were not combined. Therefore, it is still inconclusive whether acupuncture is more effective than sham acupuncture or other interventions for treating IBS.