单一针刺疗法治疗带状疱疹后遗神经痛的系统评价及Meta分析  

Systematic Review and Meta-analysis of Single Acupuncture Therapy for Postherpetic Neuralgia

作　　者：胡成想 林宝城[1] 李知行[1] 陈小砖[1] 许能贵[2] HU Cheng-Xiang;LIN Bao-Cheng;LI Zhi-Xing;CHEN Xiao-Zhuan;XU Neng-Gui(Dept.of Tendon and Muscles Injury,Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033 Guangdong,China;Clinical Medical School of Acupuncture,Moxibustion and Rehabilitation,Guangzhou University of Chinese Medicine,Guangzhou 510006 Guangdong,China)

机构地区：[1]深圳市中医院筋伤科,广东深圳518033 [2]广州中医药大学针灸推拿康复临床医学院,广东广州510006

出　　处：《广州中医药大学学报》2022年第11期2709-2717,共9页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：深圳市“三名工程”资助项目(编号:SZSM201812066)。

摘　　要：【目的】系统评价单一针刺疗法治疗带状疱疹后遗神经痛的临床有效性及安全性。【方法】通过计算机系统检索中国期刊全文数据库(CNKI)、万方学术期刊全文数据库(Wanfang)、维普中文科技期刊数据库(VIP)、中国生物医学数据库(SinoMed)、美国医学在线(PubMed)及国际循证医学图书馆(Cochrane Library)六大数据库中有关针刺治疗带状疱疹后遗神经痛的随机对照研究,文献筛选后,应用Rev Man 5.3进行Meta分析,采用GRADE profiler 3.6进行证据质量分级。【结果】共纳入16项研究,共计1255例患者。Meta分析结果提示:单一针刺疗法对比西药治疗,可提高带状疱疹后遗神经痛的临床总有效率[RR=1.22,95%CI(1.15,1.29),P<0.05],亚组分析表明:针刺亚组可提高临床总有效率[RR=1.21,95%CI(1.13,1.28),P<0.05],电针亚组与西药组无显著差异[RR=1.25,95%CI(0.96,1.63),P=0.10]。单一针刺疗法视觉模拟量表(VAS)评分比西药组更低[SMD=-2.66,95%CI(-3.77,-1.55),P<0.05],亚组分析:针刺亚组VAS评分低于西药组[SMD=-3.76,95%CI(-5.80,-1.72),P<0.05],温针亚组VAS评分比西药组低[SMD=-1.72,95%CI(-2.15,-1.29),P<0.05],电针亚组相对于西药组无明显降低[SMD=-0.64,95%CI(-1.85,0.57),P=0.30],针刺较西药治疗可降低头痛、恶心、呕吐等不良反应的发生[RR=0.10,95%CI(0.02,0,50),P<0.05]。【结论】单一针刺疗法治疗带状疱疹后遗神经痛可提高临床有效率、降低VAS评分,减少不良反应发生。Objective To systematically evaluate the clinical efficacy and safety of single acupuncture therapy for postherpetic neuralgia(PHN).Methods The randomized controlled studies on acupuncture for PHN were screened by computer system in six major databases:CNKI,Wanfang,VIP,SinoMed,PubMed,and Cochrane Library,and Meta-analysis was performed using Rev Man 5.3 and the quality of evidence was graded using GRADE profiler 3.6.Results A total of 16 studies with 1255 patients were included.Meta-analysis results suggested that single acupuncture therapy improved the total clinical efficiency of PHN compared with western medicine[RR=1.22,95%CI(1.15,1.29),P<0.05],and subgroup analysis showed that the acupuncture subgroup improved the total clinical efficiency[RR=1.21,95%CI(1.13,1.28),P<0.05],and there was no significant difference in the electro-acupuncture subgroup compared to the western medicine group[RR=1.25,95%CI(0.96,1.63),P=0.10].The Visual Analogue Scale(VAS)score of single acupuncture therapy was lower than that of western medicine group[SMD=-2.66,95%CI(-3.77,-1.55),P<0.05].Subgroup analysis:VAS score of acupuncture subgroup was lower than that of western medicine group[SMD=-3.76,95%CI(-5.80,-1.72),P<0.05],and VAS score of warm needling subgroup was lower than that of western medicine group[SMD=-1.72,95%CI(-2.15,-1.29),P<0.05],there was no significant decrease in electroacupuncture subgroup compared with western medicine group[SMD=-0.64,95%CI(-1.85,0.57),P=0.30].Compared with western medicine treatment,acupuncture could reduce the incidence of headache,nausea,vomiting and other adverse reactions[RR=0.10,95%CI(0.02,0,50),P<0.05].Conclusion Single acupuncture therapy has effects in improving the clinical efficiency,reducing VAS score and the occurrence of adverse reactions in the treatment of PHN.

关 键 词：针刺 带状疱疹后遗神经痛 系统评价 META分析 随机对照试验 VAS评分 临床有效率 

分 类 号：R246.9[医药卫生—针灸推拿学]