Acupoint Herbal Patching for Asthma: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Acupoint Herbal Patching for Asthma: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
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DOI：
10.1097/md.0000000000002439
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发表时间：
2016-01
期刊：
影响因子：
1.6
通讯作者：
Lee H
中科院分区：
文献类型：
--
作者：
Lee SH;Chang GT;Zhang X;Lee H
穴位草药贴敷（AHP），涉及用草药贴敷局部穴位刺激，长期以来一直用于治疗东亚国家的哮喘患者。然而，它的证据是模棱两可的。本系统评价旨在总结和批判性评价AHP治疗哮喘的有效性和安全性。在PubMed、EMBASE、科克伦图书馆和中国国家知识基础设施中检索2014年4月或之前发表的研究，这些研究是随机对照试验（RCT），检查AHP治疗本身或与其他治疗联合治疗哮喘患者。需要报告肺功能结局的试验纳入分析。使用科克伦偏倚风险评估工具评估纳入研究的偏倚风险。对于统计汇总，在随机效应模型中计算风险比、平均差（MD）或标准化MD，95%置信区间（CI）。我们最终纳入了16项随机对照试验，共1287例哮喘患者。与安慰剂组相比，AHP组第一秒用力呼气量（FEV 1）改善13%（MD = 12.99%，95%CI 5.17%-20.81%），哮喘症状改善60%（AHP组症状不变或恶化的风险比=0.4，95%CI 0.27-0.58）。 然而，由于数据的异质性和缺乏，证据有限。在常规治疗的基础上，AHP显著改善了FEV 1/用力肺活量比值11.6%（95%CI 8.49%-14.79%），降低了哮喘症状风险69%（95%CI 0.16-0.58）。与常规药物相比，AHP显著改善FEV 1（标准化MD = 0.46，95%CI 0.05-0.87），但检测到显著异质性（I2 = 53%）。 当添加到中草药中时，AHP对肺功能或整体症状改善没有额外的好处。没有与AHP相关的严重不良事件。AHP有效性的证据是令人鼓舞的，但不是决定性的，因为临床多样性和高风险的偏倚研究。需要进一步的临床和基础研究来确定AHP在哮喘患者肺功能和症状改善中的作用。
Supplemental Digital Content is available in the text Acupoint herbal patching (AHP), which involves local point stimulation with a herbal medicine patch, has long been used to treat patients with asthma in East Asian countries. However, its evidence is equivocal. This systematic review aims to summarize and critically evaluate the efficacy and safety of AHP for asthma. A literature search was conducted in PubMed, EMBASE, the Cochrane library, and the China National Knowledge Infrastructure for studies published on or before April 2014, which were randomized controlled trials (RCTs) examining AHP therapy by itself or in combination with other treatments in asthma patients. Trials needed to report pulmonary function outcomes to be included in analyses. The risk of bias of included studies was assessed using the Cochrane risk of bias assessment tool. For statistical pooling, risk ratio, mean difference (MD), or standardized MD was calculated with 95% confidence intervals (CIs) in a random-effects model. We ultimately included 16 RCTs with 1287 asthmatic patients in analyses. Treatment with AHP improved forced expiratory volume in 1 second (FEV1) by 13% (MD = 12.99%, 95% CI 5.17%–20.81%) and asthmatic symptoms by 60% (risk ratio of unchanged or getting worse symptoms with AHP = 0.4, 95% CI 0.27–0.58) over that observed with placebo. However, evidence is limited due to the heterogeneity and paucity of data. When added to conventional therapies, AHP significantly improved the FEV1/forced vital capacity ratio by 11.6% (95% CI 8.49%–14.79%) and reduced the risk of asthmatic symptoms by 69% (95% CI 0.16–0.58). Compared with conventional medication, AHP significantly improved FEV1 (standardized MD = 0.46, 95% CI 0.05–0.87), but a substantial heterogeneity was detected (I2 = 53%). When added to Chinese herbal medicine, there were no additional benefits of AHP on pulmonary function or global symptom improvement. No serious adverse events were associated with AHP. Evidence for AHP efficacy is encouraging, but not conclusive, because of clinical diversity and the high risk of bias in the examined studies. Further clinical and basic research is needed to determine the role of AHP in lung function and symptom improvement in patients with asthma.