Meta-analysis and GRADE evaluation of efficacy and safety of acupoint catgut embedding in the treatment of functional constipation
Objective:To systematically evaluate the efficacy and safety of acupoint catgut embedding in the treat-ment of functional constipation(FC)and the quality of the included evidence,so as to provide evidence-based medical evi-dence for clinical decision-making.Methods:China National Knowledge Infrastructure,Wanfang Knowledge Service Plat-form,VIP Chinese Journal database,China Biomedical Literature Service System,Embase,PubMed and Cochrane Library databases were searched to collect randomized controlled trials(RCTS)of acupoint catgut embedding therapy for FC.The retrieval time was from the establishment of the database to October 16,2023.Literature screening,data extraction and bias risk assessment were performed independently by two researchers.Meta-analysis was performed by using RevMan 5.4 soft-ware,and GRADE was used to evaluate the evidence quality of each outcome indicators.Results:A total of 19 RCTS were included,including 1673 patients.Meta-analysis results showed that,compared with control group,acupoint catgut em-bedding therapy for FC could improve the total effective rate(RR=1.23,95%CI=(1.17,1.29),P<0.000 01],increase com-pletely spontaneous bowel movements(CSBM)times[MD=0.61,95%CI=(0.11,1.10),P=0.02],improve fecal traits[MD=0.53,95%CI=(0.31,0.76),P<0.000 01]and difficult defecation[MD=-0.71,95%CI=(-1.03,-0.40),P<0.000 01],shorten defecation time[MD=-0.50,95%CI=(-0.72,-0.29),P<0.000 01],and improve patient assessment of constipation quality of life questionnaire(PAC-QOL)[MD=-7.72,95%CI=(-12.83,-2.61),P<0.003].There was no statistical significance in the incidence of adversc reuctions between the two groups[RR=0.37,95%CI=(0.10,1.38),P=0.14].GRADE evidence grade evaluation results showed that the total effective rate was medium grade evidence quality,the incidence of adverse re-actions,fecal traits score and difficult defecation score were low grade evidence quality,and the number of CSBM,defeca-tion time and PAC-QOL were very low grade evidence quality.Conclusion:Acupoint catgut embedding treatment of FC has a certain effect,can improve constipation-related symptoms,and does not increase the incidence of adverse reactions.However,the quality of the included studies is generally low,and the above conclusions need to be verified by more high-quality studies.
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