中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (5): 813-820.doi: 10.12307/2022.132

• 组织构建循证医学 evidence-based medicine in tissue construction • 上一篇    

不同针刺方法治疗腰椎间盘突出症的网状Meta分析

王  楠,钱宇章,谢  林   

  1. 南京中医药大学附属中西医结合医院骨伤科,江苏省中医药研究院,江苏省南京   210000

  • 收稿日期:2020-11-05 修回日期:2020-11-06 接受日期:2021-01-07 出版日期:2022-02-18 发布日期:2021-12-03
  • 通讯作者: 谢林,男,博士,主任中医师,研究员,博士生导师,南京中医药大学附属中西医结合医院骨伤科,江苏省中医药研究院,江苏省南京 210000
  • 作者简介:王楠,男,1993年生,江苏省人,汉族,南京中医药大学在读博士。
  • 基金资助:
    江苏省中医药领军人才培养项目(SLJ0210),项目负责人:谢林;江苏省科技厅社会发展重点项目(BE2019765),项目负责人:谢林

Network Meta-analysis of different acupuncture methods for the treatment of lumbar disc herniation 

Wang Nan, Qian Yuzhang, Xie Lin   

  1. Department of Orthopedic Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China 
  • Received:2020-11-05 Revised:2020-11-06 Accepted:2021-01-07 Online:2022-02-18 Published:2021-12-03
  • Contact: Xie Lin, MD, Chief physician, Researcher, Doctoral supervisor, Department of Orthopedic Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
  • About author:Wang Nan, MD candidate, Department of Orthopedic Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
  • Supported by:
    Jiangsu Provincial Leading Talent Training Project for Traditional Chinese Medicine, No. SLJ0210 (to XL); the Social Developmental Project of Jiangsu Provincial Science and Technology Department, No. BE2019765 (to XL) 

摘要:

文题释义:
网状Meta分析:又名多重治疗比较Meta分析,发展于传统Meta分析,不同于标准的2组试验进行比较,其可将多种不同因素归纳到一起,对同一疾病的不同干预措施进行相互比较,最终进行定量化统计分析。
腰椎间盘突出症:是腰椎退行性疾病,由于纤维环发生破裂后,其内部髓核突出于外,压迫或刺激窦椎神经及神经根而引起的以腰腿疼痛麻木为主要表现的一种综合征。

目的:针刺治疗腰椎间盘突出症具有良好的疗效,但是针刺方法较多,且临床研究多为两两比较,缺乏几种常用针刺方法治疗效果的直接比较。针刺治疗腰椎间盘突出症方法较多,其中以腹针、浮针、温针、电针、平衡针及常规针刺居多,临床运用广泛。故文章采用网状Meta分析以系统评价此6种针刺方法治疗腰椎间盘突出症的有效性及安全性。
方法:计算机检索PubMed、EMbase、Cochrane Library、中国生物医学文献服务系统(SinoMed),中国知网、万方和维普数据库,由2名作者分别单独检索、筛查相关文献,并从检索结果中提取有效数据,最终纳入针刺方法治疗腰椎间盘突出症的随机对照试验类文章。采用Cochrane Handbook中的偏倚风险工具评估文献质量,最后采用RevMan 5.3,Stata 14和Gemtc 0.14.3软件进行数据分析。
结果:最终纳入43项随机对照试验,文献质量尚可,共5 175例患者。网状Meta分析结果表明:①在临床有效率方面,6种针刺方法均能取得良好的疗效,各干预措施疗效概率排序为:腹针(0.97)>温针(0.47)>浮针(0.44)>电针(0.53)>平衡针(0.52)>常规针刺(0.98);②在降低目测类比疼痛评分方面,概率排序为:浮针(0.4)>温针(0.4)>腹针(0.26)>电针(0.44)>平衡针(0.56)>常规针刺(0.79);③在安全性方面,纳入文献中仅8篇提及不良反应情况,其中5篇未见明显不良反应事件,有3篇虽有提及进针点疼痛及发生皮下血肿等事件,但处理后均无遗留症状。
结论:①腹针、温针、浮针、电针、平衡针和常规针刺法治疗腰椎间盘突出症均具有良好的优势,且无明显严重不良反应;②腹针治疗的总体临床疗效最佳;③浮针缓解降低腰腿痛方面效果最佳,当疼痛严重时可指导临床优先考虑;④未来仍需要高质量的多中心、大样本、随机双盲对照试验来验证此结论的可靠性。

https://orcid.org/0000-0002-7605-8634 (王楠) 

中国组织工程研究杂志出版内容重点:组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程

关键词: 针刺, 腹针, 浮针, 温针, 电针, 平衡针, 腰椎间盘突出症, 网状Meta分析

Abstract: OBJECTIVE: Acupuncture treatment for lumbar disc herniation has good results. However, there are many acupuncture methods. Pairwise comparisons have been mostly used in existing clinical studies, and there is a lack of direct comparisons of the therapeutic effects of several common acupuncture methods. Various acupuncture methods have been used for the treatment of lumbar disc herniation, among which abdominal, floating, warm, electroacupuncture, balance and conventional acupuncture are the most popular and have been widely used in clinical practice. Therefore, we evaluated the efficacy and safety of six acupuncture methods in the treatment of lumbar disc herniation with network Meta-analysis. 
METHODS: Seven databases including PubMed, EMbase, Cochrane Library, SinoMed, CNKI, WanFang and VIP were searched by computers. Two reviewers independently searched, screened and extracted the data, and randomized controlled trials regarding acupuncture for treating lumbar disc herniation were finally included. Quality of the literatures was assessed using the risk of bias tool in the Cochrane Handbook, and RevMan 5.3, Stata 14 and Gemtc 0.14.3 software were used for data analysis
RESULTS: Forty-three randomized controlled trials involving 5 175 patients were finally included and the quality assessment of the literatures was acceptable. The results of network Meta-analysis showed that: (1) in terms of clinical efficiency, all the six acupuncture methods could achieve good curative effects, and the order of efficacy probability was ranked as follows: abdominal needle (0.97) > warm needle (0.47) > floating needle (0.44) > electroacupuncture (0.53) > balance needle (0.52) > conventional acupuncture (0.98). (2) In terms of reducing visual analog scale scores, the order of probability was: floating needle (0.4) > warm needle (0.4) > abdominal needle (0.26) > electroacupuncture (0.44) > balance needle (0.56) > conventional acupuncture (0.79). (3) In terms of safety, only eight of the included literatures mentioned adverse reactions, five of which had no obvious adverse reaction events, and three articles mentioned the occurrence of needle insertion point pain and subcutaneous hematoma, but no symptoms remained after treatment. 
CONCLUSION: Six acupuncture methods, including abdominal, floating, warm, electroacupuncture, balance and conventional acupuncture, all have good advantages in the treatment of lumbar disc herniation, with no obvious serious adverse reactions. Abdominal needle ranks first in overall clinical efficacy. Floating needle has the first possibility in reducing low back and leg pain. When a severe pain occurs, floating needle can be clinically prioritized. However, high-quality, multicenter, large-sample, randomized double-blind controlled trials are required to verify the reliability of this conclusion.

Key words: acupuncture, abdominal needle, floating needle, warm needle, electroacupuncture, balance needle, lumbar disc herniation, network Meta-analysis

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