目的:评价温针灸治疗腹泻型肠易激综合征的临床疗效和安全性.方法:检索中国知网、中国生物医学文献数据库、万方、维普、Cochrane、Medline、Web of science、ScienceDirect、PubMed和Embase全文电子期刊数据库自建库以来所有关于温针灸治疗腹泻型肠易激综合征的文献,筛选温针灸治疗腹泻型肠易激综合征的临床随机对照试验.参照Cochrane手册(Version 6.3,2022)对纳入研究进行信息提取和发表偏倚风险评价,以临床有效率、临床痊愈率、中医证候积分、不良反应、复发率及相关量表评分为结局指标.采用RevMan 5.4进行文献质量评价、异质性检验并进行Meta分析.结果:纳入15项研究,患者共计1105例.Meta分析结果显示:温针灸对于腹泻型肠易激综合征临床有效率(RR=1.23,95％CI[1.17,1.30],P＜0.000 01)和痊愈率(RR=1.78,95％CI[1.41,2.25],P＜0.000 01)均优于普通针刺和西药.温针灸在改善腹泻型肠易激综合征患者中医证候总积分(MD=-1.12,95％CI[-1.71,-0.53],P=0.000 2)方面也优于普通针刺和西药.肠易激综合征病情严重程度量表(IBS Symptom Severity Scale,IBS-SSS)评分显示肠易激综合征症状明显改善(MD=-49.05,95％CI[-68.50,-29.60],P＜0.00001).医院焦虑抑郁量表(Hospital Anxiety and Depression Scale,HADS)评分提示温针灸和普通针刺或西药均可改善腹泻型肠易激综合征患者焦虑、抑郁,温针灸改善焦虑的效果与普通针刺或西药无差别(MD=-0.12,95％CI[-0.56,0.33],P=0.61),但改善抑郁状态的效果明显优于普通针刺和西药(MD=-0.90,95％CI[-1.43,-0.37],P=0.000 8).安全性分析发现温针灸复发率明显低于普通针刺或西药(RR=0.42,95％CI[0.26,0.70],P=0.000 8),且未见明显不良反应.结论:温针灸治疗腹泻型肠易激综合征相较于普通针刺或西药有一定优势,能够明显改善腹泻型肠易激综合征患者躯体症状,提高其生活质量,温针灸可以作为西药不耐受患者的替代疗法,但需要更多的多中心、高质量随机对照试验研究证实当前研究.
A Meta-analysis of the clinical efficacy of warm needling moxibustion in the treatment of irritable bowel syndrome with diarrhea
Objective:To evaluate the clinical efficacy and safety of warm needling moxibustion in the treatment of IBS-D.Methods:The literature in CNKI,CBM,Wanfang,VIP,Cochrane,Medline,Web of science,ScienceDirect,PubMed,and Embase database about warm needling moxibustion in the treatment of IBS-D was retrieved to screen out the RCTs.Cochrane Handbook(Version 6.3,2022)was used for information extraction and risk of bias assessment.Clinical efficacy,cure rate,TCM syndrome score,adverse reactions,recurrence rate,and related scale scores were used as outcome indicators.RevMan 5.4 was used to evaluate the quality of literature and heterogeneity test,and performs Meta-analysis.Results:A total of 15 studies were included.The total number of patients was 1 105.Meta-analysis results showed that clinical efficiency(RR=1.23,95％CI[1.17,1.30],P＜0.000 01)and healing rate(RR=1.78,95％CI[1.41,2.25],P＜0.000 01)of warm needling moxibustion in the treatment of IBS-D were superior to ordinary acupuncture or Western medicine.Warm needling moxibustion was superior to ordinary acupuncture or Western medicine in ameliorating the total score of TCM symptoms of IBS-D patients(MD=-1.12,95％CI[-1.71,-0.53],P=0.000 2).IBS-SSS scores showed that IBS symptoms were obviously ameliorated(MD=-49.05,95％CI[-68.50,-29.60],P＜0.000 01).The HADS anxiety and depression scores showed that warm needling moxibustion could ameliorate anxiety and depression emotions of the patients,the efficiency of warm needling moxibustion on anxiety was not different from that of ordinary acupuncture or Western medicine(MD=-0.12,95％CI[-0.56,0.33],P=0.61),but the amelioration of depressive state was significantly superior to ordinary acupuncture or Western medicine(MD=-0.90,95％CI[-1.43,-0.37],P=0.000 8).The security analysis showed that the recurrence rate of warm needling moxibustion was significantly lower than that of ordinary acupuncture or Western medicine(RR=0.42,95％CI[0.26,0.70],P=0.000 8),and there was no significant adverse reaction.Conclusion:Warm needling moxibustion has certain advantages compared with ordinary acupuncture or Western,and can significantly relieue IBS-D.It can be used as an alternative therapy for patients with Western medicine intolerance,but more multi-center,quality RCTs should be done to confirm the discovery.
Warm needling moxibustionIrritable bowel syndrome with diarrheaMoxibustionMeta-analysis
万方数据
维普
