Acupuncture for Opioid Dependence Patients Receiving Methadone Maintenance Treatment: A Network Meta-Analysis.
Acupuncture for Opioid Dependence Patients Receiving Methadone Maintenance Treatment: A Network Meta-Analysis.
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针灸治疗接受美沙酮维持治疗的阿片类药物依赖患者：网络荟萃分析
DOI：
10.3389/fpsyt.2021.767613
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发表时间：
2021
影响因子：
4.7
通讯作者：
Lu L
中科院分区：
文献类型：
--
作者：
Wen H;Chen R;Zhang P;Wei X;Dong Y;Ge S;Luo W;Zhou Y;Xiao S;Lu L
目标：阿片类药物依赖数百年来一直对公众健康构成威胁。随着针对接受美沙酮维持治疗（MMT）的阿片类药物依赖患者的针灸相关治疗研究不断增多，针灸治疗MMT患者的疗效仍存在争议。因此，我们进行了多治疗荟萃分析，并结合直接和间接比较，以发现接受MMT的阿片类药物依赖患者最有效的治疗方法。方法：检索5个英文数据库和3个中文数据库，从建库至2020年8月20日，比较针灸相关疗法和MMT（下文中将其概括为西医（WM））的效果。根据Cochrane偏倚风险工具5.1.0评估研究质量，并使用R软件（3.6.1版）和STATA（14.0版）进行配对荟萃分析、累积荟萃分析和网络荟萃分析。主要结局是有效率，根据戒毒患者占总人数的比例计算。次要结果是改良希梅尔斯巴赫阿片戒断量表（MHOWS）。结果：共纳入20项试验，包括西医、中医和四种针灸疗法（徒手针灸（MA）、电针（EA）、耳针（AA）和经皮穴位电刺激（TEAS））之间的比较。尽管没有一项试验的偏倚风险较低。在配对荟萃分析中，在有效率方面没有观察到统计学上的显着差异。此外，在 MHOWS 中，MA 比 WM、EA 和 TEAS 更有效，平均差 (MD) 为 (-8.59, 95% CI: -15.96 至 -1.23, P < 0.01)、(-6.15, 95% CI: -9.45 至 -2.85, P < 0.05) 和 (-10.44, 95% CI:分别为-16.11至-4.77，P < 0.05）。在网络荟萃分析中，MA在有效率上比WM更有效（RR：1.40，95％CI：1.05至1.99），在MHOWS上（MD：-5.74，95％CI：-11.60至-0.10）。对于 MHOWS，TEAS 比 WM 更有效（MD：-15.34，95% CI：-27.34 至 -3.46）。综合来看，MA 在治疗阿片类药物依赖方面排名第一的可能性最高。结论：现有证据表明，针灸相关疗法可有效用于治疗接受MMT的患者，并且手法针灸可能是各种针灸相关疗法中治疗阿片类药物依赖的最佳选择。然而，减少阿片类药物依赖复发、促进其康复，不仅需要医疗行业的努力，还需要政府的支持、保障体系、教育普及等方面的努力。为了加强针灸相关疗法治疗阿片类药物依赖的保证，我们期望进行高质量的临床试验，以提供更有说服力的证据。
Objectives: Opioid dependence has been a threat to public health for hundreds of years. With the increasing number of studies on acupuncture-related therapies for opioid dependence patients receiving methadone maintenance treatment (MMT), its effect of acupuncture therapy in treating MMT patients remains controversial. Therefore, we conducted a multiple-treatments meta-analysis, and incorporated both direct and indirect comparisons, in order to discover the most effective treatment for opioid dependence patients receiving MMT. Methods: Five English databases and three Chinese databases were searched from its inception to August 20, 2020, in order to compare the effects of acupuncture-related therapies and MMT, which was summarized as Western medicine (WM) in the following texts. The quality of studies was assessed according to Cochrane's risk of bias tool 5.1.0, and a pair-wise meta-analysis, cumulative meta-analysis, and the network meta-analysis was performed using the R software (Version 3.6.1) and STATA (Version 14.0). The primary outcome was the effective rate, which was calculated by the ratio of detoxifying patients to the total. The secondary outcome was the Modified Himmelsbach Opiate Withdrawal Scale (MHOWS). Results: A total of 20 trials were included, which consisted of comparisons among WM, traditional Chinese medicine (TCM), and the four types of acupuncture, namely, manual acupuncture (MA), electro-acupuncture (EA), auricular acupuncture (AA), and transcutaneous electrical acupoint stimulation (TEAS). Though none of the trials were at low risk of bias. In the pair-wise meta-analysis, no statistically significant differences were observed in terms of the effective rate. Furthermore, MA was more efficacious than WM, EA, and TEAS in MHOWS, with mean differences (MDs) of (−8.59, 95% CI: −15.96 to −1.23, P < 0.01), (−6.15, 95% CI: −9.45 to −2.85, P < 0.05), and (−10.44, 95% CI: −16.11 to −4.77, P < 0.05), respectively. In the network meta-analysis, MA was more effective than WM (RR: 1.40, 95% CI: 1.05 to 1.99) on the effective rate, and (MD: −5.74, 95% CI: −11.60 to −0.10) on MHOWS. TEAS was more effective than WM (MD: −15.34, 95% CI: −27.34 to −3.46) on MHOWS. Synthetically, MA had the highest probability to rank first in treating opioid dependence. Conclusions: The existing evidence shows that acupuncture related-therapies may effectively be used for treating patients receiving MMT, and that manual acupuncture may be the best choice for opioid dependence among all kinds of acupuncture-related therapies. Nevertheless, reducing the relapse and promoting the recovery of opioid dependence need more efforts from not only the medical industry but also government support, security system, and educational popularization. To strengthen the assurance of acupuncture-related therapies in the treatment of opioid dependence, we expected that clinical trials with high quality would be conducted, to provide more confident evidence.
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影响因子：
17.7
作者：
Kolb, L;Himmelsbach, CK
通讯作者：
Himmelsbach, CK
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