针刺对比药物预防治疗偏头痛有效性及安全性的Meta分析  

Effectiveness and safety of acupuncture versus drug treatment for migraine prophylaxis:a meta-analysis

作　　者：蒲圣雄 谭戈[1] 邓勇[1] 黎伦晞 朱秋汶 姜花花 

机构地区：[1]重庆医科大学附属第一医院神经内科,重庆400016

出　　处：《重庆医科大学学报》2017年第10期1293-1298,共6页Journal of Chongqing Medical University

基　　金：重庆市卫计委中医药科技项目(ZY201403007)

摘　　要：目的:系统评价针刺对比药物对偏头痛的预防治疗疗效及安全性,为针刺的临床应用提供循证依据。方法:检索Pubmed、The Cochrane library、EMBASE、CBM、VIP、Wan Fang Data和CNKI,检索时间为建库至2015年12月,收集针刺和药物对偏头痛的预防治疗的随机对照研究。筛选合格的文献并提取相关数据,结局数据按照随访时间分为随机后3~4月和随机后5~6月2个亚组,最后进行Meta分析。结果:根据纳入排除标准筛选后共纳入研究7项,包含1285名偏头痛患者。Meta分析结果显示,针刺组和药物组在随机分组后随访3~4月的治疗有效率(RR=1.24,95%CI=1.04~1.47,P=0.020)、偏头痛天数(SMD=-0.30,95%CI=-0.45^-0.16,P=0.000)、头痛程度(SMD=-0.32,95%CI=-0.52^-0.11,P=0.000)有统计学差异,随机分组后随访5~6月的偏头痛天数(MD=-0.66,95%CI=-1.18^-0.13,P=0.010)、头痛程度(SMD=-0.31,95%CI=-0.47^-0.15,P=0.000)也有统计学意义;而随机分组后随访5~6月的治疗有效率(RR=1.18,95%CI=0.97~1.43,P=0.110)2组间无统计学差异;因此针刺组相对药物治疗组,治疗有效率更大、偏头痛天数更少,头痛程度更轻。不良反应率由于异质性较大(I2=77%),通过描述性分析认为针刺不良反应率较药物小。结论:针刺相对药物对偏头痛的预防治疗有更好的治疗效应及安全性,但还需要更多的优质试验进一步增强循证依据。Objective ：To systematically evaluate the effectiveness and safety of acupuncture and drugs for migraine prevention, and to facilitate the clinical application of acupuncture. Methods：Databases of Pubmed,Cochrane library,EMBASE,CBM,VIP,WanFang Data and CNKI were searched from database foundation to October 2015. The randomized controlled trials（RCTs） of acupuncture and drugs for migraine prophylaxis were screened .and retrieved. The outcome data were grouped 3-4 months after randomization and 5-6 months after randomization based on follow-up. And then, the included studies were assessed and data were extracted to do meta- analysis. Results：A total of 7 RCTs and 1 285 patients with migraine were included in this study. There were significant differences in response rate （RR= 1.24,95%CI= 1.04 to 1.47, P=0.020）, migraine days （SMD=-0.30,95%CI=-0.05 to -0.16, P=0.000）, intensity of headache（SMD=-0.32,95%CI=-0.52 to -0.11,P=0.000） during 3~4 months after randomization;and also in migraine days（MD= -0.66, 95%CI=- 1.18 to -0.13, P=0.010）, intensity of headache （SMD=-0.31,95%CI=-0.47 to -0.15, P=0.000） during 5-6 months after randomization; but there was no difference in response rate（RR=1.18,CI=0.97 to 1.43）,P=0.110） during 5-6 months after ran- domization. Compared to drug therapy, acupuncture group had more effectiveness, less migraine days, lighter headache intensity. It was fail to deal with heterogeneity（F=77%） of adverse events;after descriptive analysis, there was less adverse events in research period. Conclusion：Acupuncture had better clinically effectiveness and more safety than drug therapy in migraine prophylaxis. More high quality researches should been carried on to enhance the reliability.

关 键 词：偏头痛 针刺 药物 预防治疗 META分析 

分 类 号：R246.6[医药卫生—针灸推拿学]