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目的：通过meta分析综合评价针刺对支气管哮喘急性发作期的临床疗效。方法：通过计算机检索8个数据库（PubMed、Embase、Web of Science、The Cochrane Library、中国生物医学文献数据库、维普数据库、中国知网和万方）从建库至2024年10月1日针刺治疗哮喘急性发作期的随机对照试验。2名研究员独立评估纳入文献的质量并提取数据。使用RevMan 5.4对数据进行合并和分析。二分类结果以风险比（RR）报告，连续结果以均数差（SD）/标准化均数差（SMD）报告，均报告95%CI。采用Cochrane工具评估偏倚风险，采用GRADE方法对证据质量进行评级。结果：共纳入19项随机对照试验，涉及2 137名患者。meta分析结果显示：针刺治疗后的有效率[RR=2.01,95%CI(1.32,3.06),n=90,I2=0%,P=0.001，低质量]优于假针，针刺治疗后的中医症状体征总积分[MD=-5.99,95%CI（-9.32，-2.66）,n=90,I2=93%,P=0.000 4，低质量]低于假针。与药物治疗相比，针刺可提高治疗后的的IFN-γ水平[SMD=0.27,95%CI(0.02,0.53),n=249,P=0.04,I2=3%，低质量]，FVC[SMD=0.54,95%CI(0.15,0.94),n=233,I2=52%, P=0.006，极低质量]，降低治疗后中医症状体征总积分[MD=-1.04,95%CI（-1.76，-0.32）,n=606,I2=76%,P<0.000 01，低质量]。但是，针刺对治疗后有效率[RR=1.11,95%CI(0.98,1.26),n=1 006,I2=94%,P=0.11，极低质量]、 FEV1[SMD=0.10,95%CI（-0.29,0.49）,n=1329,I2=90%,P=0.61，极低质量]、FEV1/FVC[MD=1.40,95%CI（-2.45,5.25）,n=840,I2=71%, P=0.47，极低质量]、PEF[SMD=0.13,95%CI（-0.23,0.48）,n=1239,I2=87%,P=0.49，极低质量]和IL-4[SMD=-0.43,95%CI（-1.04,0.18）,n=249,I2=82%,P=0.17，极低质量]与药物治疗相比几乎没有差异。针刺联合对照可提高治疗的有效率[RR=1.22,95%CI(1.13,1.32),n=418, I2=0%，中质量]、IFN-γ[MD=4.96,95%CI(3.23,6.68),n=234,I2=43%,P<0.000 01，低质量]和治疗后肺功能，包括FVC[SMD=0.57,95%CI(0.31,0.83),n=234,I2=0%, P<0.000 01，低质量]、FEV1[SMD=1.03,95%CI(0.31,1.76),n=464,I2=92%, P=0.005，低质量]和PEF[SMD=1.27,95%CI(0.23,2.31),n=288,I2=94%,P=0.02，极低质量]。但与对照组相比联合治疗对治疗后FEV1/FVC[MD=11.54,95%CI（-1.03,24.11）,n=230,I2=97%,P=0.07，极低质量]和治疗后IL-4水平[MD=-8.78,95%CI （-18.31,0.76）,n=234,I2=90%, P=0.07，极低质量]几乎没有差异。结论：证据表明针刺在治疗急性哮喘加重期可能比假针灸更有效。联用针刺的综合疗法在提高治疗的有效率、改善肺功能以及促进IFN-γ表达比单用药物更有效。然而，研究之间的证据强度较低，需要新的高质量研究来提供更明确的证据。
Abstract：Objective: To comprehensively evaluate the clinical efficacy of acupuncture on acute exacerbations of bronchial asthma through a meta-analysis. Methods: RCTs of acupuncture for the treatment of acute exacerbations of bronchial asthma in eight databases(PubMed, Embase, Wos, Cochrane Library, Sinomed, Wipu, CNKI, and Wanfang) were searched by computer from the time of construction to October 1, 2024. Two reviewers separately appraised the risk of bias and extracted the data. Data were combined and analyzed using RevMan 5.4. Dichotomous outcomes were reported as RRs, and continuous outcomes were reported as SMDs with 95% CIs. The bias risk was evaluated via the application of the Cochrane tool, while the evidence was graded using the GRADE approach. Results: A total of 19 randomized controlled trials involving 2 137 patients were included.The results of the meta-analysis showed that the effective rate after acupuncture treatment(RR=2.01, 95% CI 1.32 to 3.06, n=90, I2 = 0%, P=0.001, low quality) was superior to that of the sham acupuncture, and the total score of traditional Chinese medicine symptoms and signs after acupuncture treatment(MD-5.99, 95% CI-9.32 to-2.66, n=90, I2 = 93%, low quality) was lower than that of the sham acupuncture. The results of the meta-analysis showed that the level of IFN-γ after acupuncture treatment(SMD 0.27, 95% CI 0.01 to 0.53, n=249, I2 = 3%, low quality) 、FVC(SMD 0.54,95%CI 0.15,0.94,n=233,I2 =52 %, P=0.006,very low quality)was superior to that of drug treatment, and the total score of traditional Chinese medicine symptoms and signs after treatment(MD-1.04, 95% CI-1.76 to-0.32, n=606, I2 = 76%, low quality) was lower than that of drug treatment. However, acupuncture had little to no difference compared to drug treatment in terms of the effective rate after treatment(RR 1.11, 95% CI 0.98 to 1.26, n=1 006, I2 = 94%, very low quality), FEV1(SMD 0.10, 95% CI-0.29 to 0.49, n=1 329, I2 = 90%, very low quality), FEV1/FVC(MD 1.40, 95% CI-2.45 to 5.25, n=840, I2 = 71%, very low quality), PEF(SMD 0.13, 95% CI-0.23 to 0.48, n=1239, I2 = 87%, very low quality), and IL-4(SMD-0.43, 95% CI-1.04 to 0.18, n=249, I2 = 82%, very low quality). Acupuncture combined with control could improve the effective rate of treatment(RR 1.22, 95% CI 1.13 to 1.32, n=418, I2 = 0%, moderate quality) 、IFN-γ(MD 4.96,95%CI 3.23,6.68,n=234,I2 = 43%, P<0.00 001, low quality)and post-treatment lung function, including FVC(SMD 0.57, 95% CI 0.31 to 0.83, n=234, I2 = 0%, low quality), FEV1(SMD 1.03, 95% CI 0.31 to 1.76, n=464, I2 = 92%, low quality)and PEF(SMD 1.27, 95% CI 0.23 to 2.31, n=288, I2 = 94%, very low quality). However, there was little to no difference in post-treatment FEV1/FVC(MD 11.54, 95% CI-1.03 to 24.11, n=230, I2 = 97%, very low quality) and post-treatment IL-4 levels(MD-8.78, 95% CI-18.31 to 0.76, n=234, I2 = 90%, very low quality) when compared to the control group. Conclusion: Evidence indicates that acupuncture might demonstrate greater efficacy than sham acupuncture in addressing acute asthma exacerbations. The combination of acupuncture therapy has been shown to be more effective in enhancing treatment efficacy, improving pulmonary function, and promoting the expression of IFN-γ compared to medication alone. Nevertheless, the strength of evidence among studies is low, and new high-quality research is needed to provide more definitive evidence.
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基本信息:
DOI：10.13210/j.cnki.jhmu.20241203.002
中图分类号:R246.1
引用信息:
[1]刘祁祁,刘俊麟,杨洋,等.针刺治疗支气管哮喘急性发作期临床疗效的meta分析[J].海南医科大学学报,2025,31(06):443-456.DOI:10.13210/j.cnki.jhmu.20241203.002.
基金信息:
国家自然科学基金项目（82274420）; 黑龙江省第二批省级名中医专家传承工作室建设项目[黑中医药科教函（2021）24号]; 黑龙江省级领军人才梯队后备带头人资助项目[黑人社函（2021）296号]~~
2024-12-04
2024-12-04
2024-12-04