针灸治疗肠易激综合征的Meta分析-赵琛

第28卷第5期2010年5月CHINESEARCHIVESOFTRADITIONALCHINESEMEDICINEVo.l28No.5May2010Meta赵琛1,穆敬平2,崔云华1,杨玲1,马晓芃1,戚莉1(1.,200030;2.,442000):目的:评价针灸治疗肠易激综合征的有效性并对文献进行质量评价方法:通过计算机和手工检索获得近10年内关于针灸治疗肠易激综合征的临床随机对照试验研究,并按照循证医学原则对文献质量进行评价,并对文献结果进行Meta分析结果:有效性的异质性检验,V2=9.32,P=0.41,P0.05,无统计学意义,采用固定效应模型进行说明研究间效应量是同质的二者合并效应量的估计,RR=1.28,其95%可信区间为(1.20,1.38),经Z检验,Z=7.13,P0.00001,试验组和对照组疗效比较差异有统计学意义,并且菱形位于垂直线的右侧结论:针灸治疗组疗效优于西药对症治疗组:肠易激综合征;针灸治疗;Meta分析:R574.4:A:1673-7717(2010)05-0961-03Meta-analysisonAcupunctureandMoxibustionforIrritableBowelSyndromeZHAOChen1,MUJing-ping2,CUIYun-hua1,YANGLing1,MAXiao-peng1,QILi1(1.ShanghaiInstituteofAcupunctureMoxibustionandMeridian,Shanghai200030,China;2.TaiheHospitalofShiyanofHubeiProvince,Shiyan442000,Hube,iChina)Abstract:Objective:TosummarizetheeffectivenessofacupunctureandmoxibustionasatherapyforIrritableBowelSyndrome(IBS).Methods:RCTswereincluded,inwhichtrialsofacupunctureandmoxibustionasatherapyforIBSinrecent10yearswereextractedbycomputerandmanualsearching,forMeta-analyse.Themethodologicalqualitywasas-sessedinaccordancewiththeprinciplesofEBM.Results:Thefixedeffectmodelwastobeusedandthetestsforhetero-geneityshowsthattherewerenosignificantdifferences(V2=9.32,P=0.41,P0.05),whichmeanstheeffectsizesofthetrialswerehomogeneous.Wecombinedandestimatedtwogroups'effectsizes,RR=1.28,(95%CI-1.20to1.38).Ztestshowedthatthetherapeuticeffectoftwogroupswerehavesignificantdifferences(Z=7.143,P0.00001),andtherhombuswaslocatedattherightsideofthemediumline.Conclusion:Thetherapeuticeffectofacu-punctureandmoxibustiononIrritableBowelSyndromeissuperiortothatofwesternmedicine.Keywords:irritablebowelsyndrome;acupunctureandmoxibustion;meta-analysis:2009-12-21:(973)(2009CB522900);(08QA14064):(1973-),,,,,,(IrritableBowelSyndrome,IBS),,IBS,,19991-200812IBSMeta,IBS11.1纳入和排除标准1.1.1纳入标准¹º»,()¼,1.1.2剔除标准¹,;º;»1.2文献检索策略(1):¹,(CBMdisc),Pubmed,1999-2009IBS(2):¹:[]/;º/IrritableBowelSyndrome[MeSH]AND/Acu-puncture0/moxbustion0(3)4:56565656(19991-200812),1.3评价方法(1):Jadad[1],¹,(2,2:;1:961DOI10.13193/j.archtcm.2010.05.67.zhaoch.032第28卷第5期2010年5月CHINESEARCHIVESOFTRADITIONALCHINESEMEDICINEVo.l28No.5May2010);º,;»(0~2,2:,;1:;0:);¼,(0~1);RCT1~5,3,1~2;,,(2):,,:()(3):,1.4统计学分析CochraneRevMan4.2,P0.05,,(relativerisk,RR),95%(confidenceinterva,lCI),P0.0522.1检出文献情况,,131128,310,81044,36,()26,7,2,3[2,16-17],33[3-5]2.2质量评价2.2.1样本来源及样本含量10,2,3,,546~1682.2.2随机对照情况106,3[4,10,16],1[9]2.2.3诊断标准及疗效评定标准6,3[4,8,13],1[14],3[6-7,13],2.2.4基线情况,8,/0,,3[6,9,17]2.2.5随访及退出或失访情况,1[11]2.2.6统计学结果10,3[4,11,13]2.2.7其他情况,11n(T/C)Jadad60/38137/32130/30184/84254/46125/21250/44140/25130/30235/1522.3结果分析,;10,Q,V2=9.32,P=0.41,P0.05,,,RR,RR=1.28,95%(1.20,1.38),Z,Z=7.13,P0.00001,,Meta,,12.4倒漏斗图(RR)Y,RR(/)X,(2),:,3IBS,,,,,,,,,,IBSIBSMetaRCT,,,,,,,,meta,,;,962第28卷第5期2010年5月CHINESEARCHIVESOFTRADITIONALCHINESEMEDICINEVo.l28No.5May20101Meta2Meta,;;,;,,,,,,,IBS,,V2Ridit@V2,,,,,,,,,,,,,;,;,,;,IBS,,,IBS[1]JadadAR,MooreA,CarrollD,eta1.Assessingthequalityofre-portsofrandomizedclinicaltrials:Isblindingnecessary[J].Con-trolClinTrials,1996,17(1):1-12.[2].30[J].,2007,38(296):69.[3].[J].,2003,68:11244-11245.[4].[J].,2000,23(1):35.[5].[J].,2009,27(1):111-112.[6],,.[J].,2007,26(8):17-18.[7],.35[J].,2007,26(9):30.[8],,.40[J].,2006,27(3):31-32.[9],.[J].,2006,8(4):110-111.[10],.54[J].,2006,15(6):591.[11].50[J].,2006,25(12):23.[12].30[J].,2005,28(3):35.[13].84[J].,2005,23(5):921-922.[14].[J].,2005,21(6):334-335.[15].60[J].,2002,18(3):36-37.[16].[J].,2003,3(3):206-206.[17].54[J].,2004,20(5):53.963