Acupuncture for irritable bowel syndrome: systematic review and meta-analysis.
Acupuncture for irritable bowel syndrome: systematic review and meta-analysis.
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DOI：
10.1038/ajg.2012.66
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发表时间：
2012-06
影响因子：
9.8
通讯作者：
Lao, Lixing
中科院分区：
文献类型：
--
作者：
Manheimer, Eric;Wieland, L. Susan;Cheng, Ke;Li, Shih Min;Shen, Xueyong;Berman, Brian M.;Lao, Lixing
循证治疗指南一直无法为针灸治疗肠易激综合征(IBS)的效果提供循证指导，因为之前唯一的系统性综述只包括小规模、异质性和方法学不健全的试验。我们对随机对照试验(RCT)进行了一项新的系统性综述和荟萃分析，以评估针灸治疗IBS的效果。Medline、Cochrane中央对照试验登记库、EMBASE、护理与联合健康累积索引、中国医学文献数据库、CNKI、VIP数据库，检索至2011年11月。符合条件的随机对照试验将针灸与假针灸、其他积极治疗或没有(特异性)治疗进行比较，并评估针灸作为另一种治疗的辅助。我们的结果是总体IBS症状严重程度和与健康相关的生活质量。二分法数据被合并以提供治疗后显著改善的相对风险(RR)，而连续数据被合并以提供组间治疗后评分的标准化平均差异(SMD)。纳入17个随机对照试验(N=1806)。我们没有发现与假针刺相比，针刺在症状严重程度(SMD=−0.11，95%可信区间：−0.35至0.13；4个RCT)或生活质量(SMD=−0.03，−0.27至0.22；3个RCT)方面有改善的证据。由于假对照试验结果的同质性，结果不受对4个假对照随机对照对照试验的限制，这些对照试验使用了充分的随机化、盲法，并且很少退出/退出。在没有使用安慰剂对照的随机对照试验中，针灸治疗比药物治疗(症状改善的RR=1.28，1.12~1.45；5个随机对照试验)和无(特异性)治疗(RR=2.11，1.18~3.79；2个随机对照试验)更有效。针刺与双歧杆菌比较(RR=1.07，0.90~1.27；2个随机对照试验)或针刺与心理治疗(RR=1.05，0.87~1.26；1个随机对照试验)差异均无统计学意义。在有高偏倚风险的试验中，针灸作为另一种中医治疗的辅助治疗在统计学上显著优于单独使用其他治疗(RR=1.17，1.02至1.33；4个随机对照试验)。与可信的假针灸对照相比，假对照RCT在IBS症状严重程度或IBS相关生活质量方面没有发现针灸的好处。在中国的有效性比较试验中，患者报告说，针灸比药物疗法带来的好处更多。未来的试验可能有助于澄清，据称针灸相对于药物疗法的更大好处是完全归因于患者对针灸的偏好，还是患者对针灸相对于药物有更大改善的期望。
Evidence-based treatment guidelines have been unable to provide evidence-based guidance on the effects of acupuncture for irritable bowel syndrome (IBS) because the only previous systematic review included only small, heterogeneous and methodologically unsound trials. We conducted a new systematic review and meta-analysis of randomized controlled trials (RCTs) to estimate the effects of acupuncture for treating IBS. MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, Cumulative Index to Nursing and Allied Health, and the Chinese databases Sino-Med, CNKI, and VIP were searched through November 2011. Eligible RCTs compared acupuncture with sham acupuncture, other active treatments, or no (specific) treatment, and evaluated acupuncture as an adjuvant to another treatment. Our outcomes were overall IBS symptom severity and health-related quality of life. Dichotomous data were pooled to provide a relative risk (RR) of substantial improvement after treatment, and continuous data were pooled to provide a standardized mean difference (SMD) in post-treatment scores between groups. Seventeen RCTs (N=1806) were included. We found no evidence of an improvement with acupuncture relative to sham acupuncture on symptom severity (SMD = −0.11, 95% confidence interval: −0.35 to 0.13; 4 RCTs) or quality of life (SMD = −0.03, −0.27 to 0.22; 3 RCTs). Because of the homogeneity of the results of the sham-controlled trials, results were unaffected by restriction to the 4 sham-controlled RCTs that used adequate randomization, blinding, and had few withdrawals/drop-outs. Among RCTs that did not use a placebo control, acupuncture was more effective than pharmacological therapy (RR of symptom improvement=1.28, 1.12 to 1.45; 5 RCTs) and no (specific) treatment (RR = 2.11, 1.18 to 3.79; 2 RCTs). There was no difference between acupuncture and Bifidobacterium (RR = 1.07, 0.90 to 1.27; 2 RCTs) or between acupuncture and psychotherapy (RR=1.05, 0.87 to 1.26; 1 RCT). Acupuncture as an adjuvant to another Chinese medicine treatment was statistically significantly better than the other treatment alone, in trials with a high risk of bias (RR = 1.17, 1.02 to 1.33; 4 RCTs). Sham-controlled RCTs have found no benefits of acupuncture relative to a credible sham acupuncture control on IBS symptom severity or IBS-related quality of life. In comparative effectiveness Chinese trials, patients reported greater benefits from acupuncture than from pharmacological therapies. Future trials may help clarify whether or not these reportedly greater benefits of acupuncture relative to pharmacological therapies are due entirely to patients’ preferences for acupuncture or patients’ greater expectations of improvement on acupuncture relative to drugs.
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