目的:采取Meta分析评价针灸治疗儿童变应性鼻炎的有效性和安全性.方法:计算机全面检索中国知网、维普数据库、万方、中国生物医学文献数据库(CBM)、The Cochrane Library、Web of Science、Embase、PubMed.检索自各数据库建库至2023年5月1日公开发表的关于针灸治疗儿童变应性鼻炎的全部随机对照试验研究.由两名研究者根据纳入标准和排除标准独立使用Endnote 20对文献进行筛选后提取资料,并对纳入的研究进行质量评价.使用统计软件RevMan 5.4进行Meta分析.结果:共检索到文献1 224篇,纳入随机对照试验研究21项,1 743例变应性鼻炎患儿.Meta分析结果显示:针灸联合西药治疗儿童变应性鼻炎与西药相比,总有效率优于西药(OR=4.24,95％CI=[3.06,5.87]),亚组分析结果表明:在总有效率上,针刺联合西药(OR=4.96,95％CI=[3.00,8.21])、艾灸联合西药(OR=5.15,95％CI=[2.05,12.97])、穴位贴敷联合西药(OR=3.43,95％CI=[2.12,5.56])治疗儿童变应性鼻炎均优于西药(P＜0.05);单纯针灸治疗效果与西药无明显差异(OR=1.93,95％CI=[1.12,3.35]);针灸联合西药在改善儿童变应性鼻炎的鼻症状总积分(MD=-1.27,95％CI=[-1.62,-0.92])、视觉模拟评分法(Visual Analogue Scale,VAS)评分(MD=-3.26,95％CI=[-5.96,-0.56])、鼻结膜炎生活质量调查问卷(Rhinoconjunctivitis Quality of Life Questionnatire,RQLQ)评分(MD=-3.31,95％CI=[-5.99,-0.63])方面优于西药组;针灸在降低血清免疫球蛋白E(Immunoglobulin E,IgE)水平(MD=-62.50,95％CI=[-141.25,16.26])方面与西药的差异无统计学意义(P＞0.05);针灸治疗复发率更低(OR=0.20,95％CI=[0.11,0.36]),且不会增加不良反应发生率(P＞0.05).结论:针灸治疗儿童变应性鼻炎较西药治疗具有一定的优势,可以改善变应性鼻炎相关症状,有效率更高,且复发率更低.
A Meta-analysis of randomized controlled trials of acupuncture and moxibustion in the treatment of allergic rhinitis in children
Objective:To evaluate the efficacy and safety of acupuncture and moxibustion in the treatment of allergic rhinitis in children by Meta-analysis.Methods:CNKI,VIP,Wanfang,CBM,The Cochrane Library,Web of Science,Embase and PubMed were comprehensively searched to retrieve all randomized controlled trial studies on acupuncture and moxibustion in the treatment of allergic rhinitis in children from inception of each database to May 1,2023.Endnote 20 was used to screen the included literature,and RevMan 5.4 was used for a Meta-analysis.Results:A total of 21 randomized controlled trial involving 1 743 children with allergic rhinitis were included.The results of Meta-analysis showed that acupuncture with Western medicine in the treatment of children with AR was better than that of Western medicine,OR=4.24,95％CI=[3.06,5.87],and the results of subgroup analysis showed that in terms of total effective rate,acupuncture with Western medicine(OR=4.96,95％CI=[3.00,8.21]),moxibustion with Western medicine(OR=5.15,95％CI=[2.05,12.97]),acupoint application with Western medicine(OR=3.43,95％CI=[2.12,5.56])were better than Western medicine in the treatment of AR(P＜0.05).There was no significant difference in the treatment effect of between acupuncture alone and Western medicine,OR=1.93,95％CI=[1.12 to 3.35].Acupuncture with Western medicine improved the total score of nasal symptoms in children with AR(MD=-1.27,95％CI=[-1.62,-0.92]),VAS score(MD=-3.26,95％CI=[-5.96,-0.56]),and RQLQ score(MD=-3.31,95％CI=-5.99,-0.63)were better than that of the Western medicine group.There was no significant effect between acupuncture and Western medicine in reducing IgE(MD=-62.50,95％CI=[-141.25,16.26])(P＞0.05).Acupuncture had a lower recurrence rate(OR=0.20,95％CI=[0.11,0.36])and did not increase adverse reactions(P＞0.05).Conclusion:Acupuncture and moxibustion has certain advantages over western medication in the treatment of allergic rhinitis in children.It can improve the related symptoms of allergic rhinitis with a higher effective rate and a lower recurrence rate.
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