穴位埋线治疗功能性便秘疗效与安全性Meta分析及GRADE评价  

Meta-analysis and GRADE evaluation of efficacy and safety of acupoint catgut embedding in the treatment of functional constipation

作　　者：胡露楠 林梦莹 林湖灿 杨正宁 黄雅滢 杨欣怡 刘启鸿[1,2,3] 任彦 柯晓[1,2,3] Hu Lunan;Lin Mengying;Lin Hucan;Yang Zhengning;Huang Yaying;Yang Xinyi;Liu Qihong;RenYan;Ke Xiao(The Second People′s Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou Fujian 350003;Spleen and Stomach Clinical Medical Research Center of Traditional Chinese Medicine of Fujian Province,Fuzhou Fujian 350003;Famous TCM Kexiao Studio of Fujian Province,Fuzhou Fujian 350003)

机构地区：[1]福建中医药大学附属第二人民医院,福建福州350003 [2]福建省中医脾胃临床医学研究中心,福建福州350003 [3]福建省名中医柯晓工作室,福建福州350003

出　　处：《山西中医药大学学报》2024年第5期480-489,共10页Journal of Shanxi University of Chinese Medicine

基　　金：国家自然科学基金面上项目(82274282);中央引导地方科技发展资金项目(2023L3013);柯晓福建省名中医工作室建设项目(闽卫中医〔2022〕112号)。

摘　　要：目的:系统评价穴位埋线治疗功能性便秘(FC)的疗效和安全性及纳入证据的质量,以期为临床决策提供循证医学证据。方法:检索中国知网(CNKI)、万方知识服务平台(WANFANG)、维普中文期刊数据库(VIP)、中国生物医学文献服务系统(SinoMed)、Embase、PubMed和Cochrane Library数据库,搜集穴位埋线治疗FC的随机对照试验(RCT),检索时间均从建库至2023年10月16日。由2名研究者独立完成文献筛选、资料提取及偏倚风险评估,采用RevMan 5.4软件进行Meta分析,并采用GRADE评价方法对各项结局指标进行证据质量评价。结果:最终共纳入19项RCT,包括1673例患者。Meta分析结果显示,与对照组比较,穴位埋线治疗FC可提高总有效率[RR=1.23,95%CI=(1.17,1.29),P<0.00001],增加完全自发排便(CSBM)次数[MD=0.61,95%CI=(0.11,1.10),P=0.02],改善粪便性状[MD=0.53,95%CI=(0.31,0.76),P<0.00001]及排便困难[MD=-0.71,95%CI=(-1.03,-0.40),P<0.00001],缩短排便时间[MD=-0.50,95%CI=(-0.72,-0.29),P<0.00001],改善便秘生活质量评估量表(PAC-QOL)评分[MD=-7.72,95%CI=(-12.83,-2.61),P<0.003];两组不良反应发生率比较,差异无统计学意义[RR=0.37,95%CI=(0.10,1.38),P=0.14]。GRADE证据级别评价结果显示:总有效率为中级别证据质量,不良反应发生率、粪便性状评分、排便困难评分为低级别证据质量,CSBM次数、排便时间、PACQOL评分为极低级别证据质量。结论:穴位埋线治疗FC具有一定的疗效,可改善便秘相关症状,且未增加不良反应发生率。但纳入研究质量总体偏低,上述结论尚需开展更多高质量的研究予以验证。Objective:To systematically evaluate the efficacy and safety of acupoint catgut embedding in the treatment of functional constipation(FC)and the quality of the included evidence,so as to provide evidence-based medical evidence for clinical decision-making.Methods:China National Knowledge Infrastructure,Wanfang Knowledge Service Platform,VIP Chinese Journal database,China Biomedical Literature Service System,Embase,PubMed and Cochrane Library databases were searched to collect randomized controlled trials(RCTS)of acupoint catgut embedding therapy for FC.The retrieval time was from the establishment of the database to October 16,2023.Literature screening,data extraction and bias risk assessment were performed independently by two researchers.Meta-analysis was performed by using RevMan 5.4 software,and GRADE was used to evaluate the evidence quality of each outcome indicators.Results:A total of 19 RCTS were included,including 1673 patients.Meta-analysis results showed that,compared with control group,acupoint catgut embedding therapy for FC could improve the total effective rate[RR=1.23,95%CI=(1.17,1.29),P<0.00001],increase completely spontaneous bowel movements(CSBM)times[MD=0.61,95%CI=(0.11,1.10),P=0.02],improve fecal traits[MD=0.53,95%CI=(0.31,0.76),P<0.00001]and difficult defecation[MD=-0.71,95%CI=(-1.03,-0.40),P<0.00001],shorten defecation time[MD=-0.50,95%CI=(-0.72,-0.29),P<0.00001],and improve patient assessment of constipation quality of life questionnaire(PAC-QOL)[MD=-7.72,95%CI=(-12.83,-2.61),P<0.003].There was no statistical significance in the incidence of adversc reuctions between the two groups[RR=0.37,95%CI=(0.10,1.38),P=0.14].GRADE evidence grade evaluation results showed that the total effective rate was medium grade evidence quality,the incidence of adverse reactions,fecal traits score and difficult defecation score were low grade evidence quality,and the number of CSBM,defecation time and PAC-QOL were very low grade evidence quality.Conclusion:Acupoint catgut embedding treatment of FC has a certai

关 键 词：功能性便秘 穴位埋线 随机对照试验 META分析 GRADE评价 

分 类 号：R574.4[医药卫生—消化系统]