穴位贴敷干预慢性阻塞性肺疾病稳定期系统评价和Meta分析  

Systematic Assessment and Meta-analysis of Acupoint Application for Stable Chronic Obstructive Pulmonary Disease

作　　者：胡海宇 孙敏燕 朱正阳 宣丽华[2] 虞彬艳 HU Hai-yu;SUN Min-yan;ZHU Zheng-yang;XUAN Li-hua;YU Bin-yan(Zhejiang University ofTraditional Chinese Medicine First Clinical Medical School, Hangzhou 310053, China;Zhejiang Hospital ofTraditional Chinese Medicine, Hangzhou 310053, China)

机构地区：[1]浙江中医药大学第一临床医学院,杭州310053 [2]浙江省中医院,杭州310053

出　　处：《上海针灸杂志》2019年第8期932-940,共9页Shanghai Journal of Acupuncture and Moxibustion

基　　金：浙江省中医药科技计划项目(2015ZA231);浙江中医药大学校级科研基金专项“名中医丛书编写”项目(2018CS36)

摘　　要：目的根据循证医学方法客观评价穴位贴敷疗法干预慢性阻塞性肺疾病(COPD)稳定期的临床疗效及安全性.方法综合检索国内外相关数据库,检索时间从建库至2018年5月,收集穴位贴敷与基础治疗比较干预COPD稳定期的随机对照试验.对纳入的文献进行偏倚风险和质量评估,并对穴位贴敷联合基础治疗干预COPD稳定期的总有效率(TE)、一秒用力呼气容积占用力肺活量比值(FEV1%)、气道阻塞的肺量测定(FEV1/FVC)、呼吸问卷评分(CAT)及圣乔治呼吸疾病问卷评分(SGRQ)的改善进行Meta分析,及对结局指标进行证据质量评级.结果纳入14个RCT,共计1184例患者.Meta分析结果显示,穴位贴敷联合基础治疗在提高TE[RR=1.23,95%CI(1.15,1.32),P<0.00001],增加FEV1%[MD=6.19,95%CI(3.27,9.11),P<0.0001]及FEV1/FVC[MD=4.39,95%CI(1.56,7.22),P=0.002],降低CAT[MD=﹣3.26,95%CI(﹣4.35,﹣2.16),P<0.00001]及SGRQ[MD=﹣5.55,95%CI(﹣7.93,﹣3.17),P<0.00001]方面较单纯基础治疗有明显优势;在增加FEV1/FVC[MD=0.84,95%CI(0.05,1.63),P=0.04]方面优于安慰剂联合基础治疗,但无明显提高FEV1%[MD=0.99,95%CI(﹣1.40,3.37),P=0.42].结局指标证据质量TE为低级,FEV1%、FEV1/FVC、CAT、SGRQ为极低级.1项研究报告了不良事件.结论穴位贴敷联合基础治疗可有效好转 COPD 稳定期患者临床症状,优于单纯使用基础治疗,但因文献质量及结局指标质量等级不高,仍需高质量的临床研究进一步支持.Objective To objectively assess the clinical efficacy and safety of acupoint application therapy for stable chronic obstructive pulmonary disease (COPD) according to evidence-based medicine. Method A comprehensive search was made of relevant databases at home and abroad. The retrieval time was from database construction to May, 2018. Randomized controlled trials were collected of acupoint application versus basic treatment for stable chronic obstructive pulmonary disease (COPD). An assessment was made of the bias risk and quality of the included literature. A meta-analysis was performed of the total efficacy rate (TE) of acupoint application plus basic treatment for stable COPD, the ratio of forced expiratory volume in one second to forced vital capacity (FEV1%), measurement of lung volume in airway obstruction (FEV1/FVC), the COPD Assessment Test (CAT) score and the St George’s Respiratory Questionnaire (SGRQ) score. The evidence quality of outcome measures was rated. Result Fourteen RCTs were included with a total of 1184 patients. The results of meta-analysis showed that acupoint application plus basic treatment improved TE [RR=1.23, 95% CI (1.15, 1.32), P<0.00001], increased FEV1%[MD=6.19, 95% CI (3.27,9.11), P< 0.0001] and FEV1/FVC [MD=4.39, 95% CI (1.56, 7.22), P=0.002] and decreased the CAT score [MD=-3.26, 95%CI(-4.35,- 2.16), P<0.00001] and the SGRQ score [MD=-5.55, 95% CI (-7.93,-3.17), P <0.00001] significantly more than basic treatment alone, and increased FEV1/FVC [MD=0.84, 95% CI (0.05, 1.63), P=0.04] more than placebo plus basic treatment but did not increased FEV1%[MD=0.99, 95% CI (-1.40, 3.37), P=0.42]. TE was rated as low evidence quality of outcome measures and FEV1%, FEV1/FVC, CAT and SGRQ, as very low. One study reported adverse events. Conclusion Acupoint application plus basic treatment can effectively relieve the clinical symptoms in patients with stable COPD. Its effect is superior to that of basic treatment alone. Because the quality levels of the literature and outcome measures are no

关 键 词：穴位贴敷法 肺疾病 阻塞性 系统分析 META分析 GRADE评级 

分 类 号：R246.1[医药卫生—针灸推拿学]