Efficacy and safety of acupuncture in treating low back and pelvic girdle pain during pregnancy:a systematic review and meta-analysis of randomized controlled trials
Efficacy and safety of acupuncture in treating low back and pelvic girdle pain during pregnancy:a systematic review and meta-analysis of randomized controlled trials
本研究的目的在于系统地评估和分析针灸治疗妊娠期下背痛和盆腔痛(LBPGP)的临床效果及其安全性.研究方法包括检索PubMed、EMBASE、Cochrane Library、中国知网(CNKI)、维普(VIP)和万方数据库(WanFang Database),时间跨度从2000年1月至2023年8月.研究仅纳入了妊娠周期在16至34周之间,且被诊断为LBPGP的随机对照试验(RCT).通过Meta分析,比较了单独针灸或针灸联合标准治疗(SC)与单独标准治疗的相对危险度(RRs)或平均差(MDs)以及95％置信区间(CIs).研究结果表明,共纳入了12项研究,涵盖1641位患者.在11项研究中,比较了单独针灸或针灸联合标准治疗与单独标准治疗的效果,其中3项研究同时使用了非穿透性针刺或安慰剂针刺作为对照组.与单独标准治疗相比,针灸联合标准治疗显著降低了疼痛视觉模拟评分(MD=-2.83,95％CI=-3.41 to-2.26,P＜0.00001)、剖宫产率(RR=0.69,95％CI=0.49 to 0.97,P=0.03)、早产率(RR=0.42,95％CI=0.27 to 0.65,P<0.0001)、产程(MD=-1.97,95％CI=-2.73 to?1.20,P<0.0001)以及Oswestry残疾指数评分(MD=-9.14,95％CI=?15.68 to-2.42,P=0.008).此外,针灸联合标准治疗显著提高了生活质量评定表SF-12的躯体健康评分.然而,在自然流产率、新生儿体重、嗜睡和SF-12的精神健康评分等结局上,针灸联合标准治疗与单独标准治疗相比没有显著性差异.针灸联合标准治疗和非穿透性针刺或安慰针刺联合标准治疗均可能引起轻度不良反应,如针刺部位的疼痛和流血(非持续性).综上所述,本研究表明针灸联合标准治疗在疗效上显著优于单独标准治疗,可能成为妊娠期LBPGP的潜在疗法;并且没有发现影响妊娠安全的风险,但需要更多的证据来支持这一结论.
Abstract
Objectives:Low back and pelvic girdle pain(LBPGP)is common during pregnancy.Acupuncture is an effective and safe therapy for pain relief.However,further evidence is required to confirm the efficacy and safety of acupuncture in treating LBPGP during pregnancy.This study aimed to systematically review and investigate the clinical efficacy and safety of acupuncture for the treatment of pregnancy-related LBPGP.Methods:The PubMed,EMBASE,Cochrane Library,CNKI,VIP,and WanFang databases were searched from January 2000 to August 2023.Only the randomized controlled trials(RCTs)involving pregnant women between 16 and 34 weeks of gestation diagnosed with LBPGP were included in the study.A meta-analysis was conducted and pooled risk ratios(RRs)or mean differences(MDs)with 95％confidence intervals(Cis)were compared.Results:Meta-analysis included 12 RCTs involving 1,641 participants.Eleven trials compared acupuncture alone or acupuncture combined with standard care(SC),of which three trials also used non-penetrating or placebo acupuncture as the control group.One trial compared acupuncture alone with non-penetrating acupuncture.Compared with SC,acupuncture combined with SC group significantly decreased visual analog scale score(mean difference(MD)=-2.83,95％Cl=-3.41 to-2.26,P＜0.00001),cesarean section rate(RR=0.69,95％Cl=0.49-0.97,P=0.03),preterm birth rate(RR=0.42,95％Cl=0.27-0.65,P＜0.0001),labor duration(MD=-1.97,95％Cl=-2.73 to-1.20,P＜0.0001),and Oswestry disability index score(MD=-9.14,95％Cl=-15.68 to-2.42,P=0.008).In addition,acupuncture combined with SC significantly improved 12-ltems Short Form Health Survey of physical component summaries(SF12-PCS).No significant differences were observed in the spontaneous delivery rate,newborn weight,drowsiness,and 12-ltems Short Form Health Survey of mental component summaries(SF12-MCS)between the two groups.Adverse events such as needle pain and needle bleeding were aggravated in both the SC and acupuncture treatment groups but none were associated with acupuncture during or after the treatment period.Conclusions:Meta-analysis showed that acupuncture combined with SC had better efficacy than SC alone and could be a potential therapy for LBPGP during pregnancy.The safety results imply that acupuncture caused few adverse reactions;however,more evidence is required for further confirmation.
关键词
针灸/腰背盆骨疼痛/荟萃分析/妊娠
Key words
Acupuncture/Low back and pelvic girdle pain/Meta-analysis/Pregnancy
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基金项目
grants"Pioneer"and"Leading Goose"R&D Program of Zhejiang(2023C03004)
grants"Pioneer"and"Leading Goose"R&D Program of Zhejiang(2024C03106)
Zhejiang Province Traditional Chinese Medicine Science and Technology Project(GZY-ZJ-KJ-24076)
National Key Research and Development Program of China(2023YFC3504600)
Transverse Research Project of Zhejiang University(2023-KYY-A07035-0007)
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