针刺及联合其它疗法治疗反流性食管炎的系统评价

目的 系统评价针刺对反流性食管炎（RE）的疗效。方法 检索建库至2019年5月CNKI、WANFANG、VIP、CBM、PubMed、Embase、Cochrane Library数据库中针刺治疗RE的临床随机对照研究，提取纳入文献的基本资料并评价其质量，用Rev Man5.3软件进行Meta分析。结果 共纳入13个研究，共1 120名患者。在降低复发率方面，单独针刺或针药结合均优于西药针刺:RR=0.21，95%CI(0.05，0.87)；针刺+六君疏肝方:RR=0.44，95%CI(0.27，0.71) ;针刺+半夏泻心汤加减:RR=0.29，95%CI(0.14，0.60);针刺+旋覆代赭汤合左金丸加减:RR=0.40，95%CI(0.26，0.62);针刺+自拟中药方+微波热疗:RR=0.24，95%CI(0.08，0.66)]。在内镜有效率方面，电针联合西药治疗RE优于单独西药治疗RR=1.23，95%CI(1.06，1.41)]。在降低症状积分方面，针药结合治疗RE的疗效较西药治疗更优针刺+中药:RR=-1.73，95%CI(-3.21，-0.25)，针刺+中药+西药:RR=-4.93，95%CI(-5.52，-4.34)]。针药结合治疗RE的不良反应少于单独西药治疗。结论 针药结合治疗RE安全有效且复发率低，然而单纯针刺治疗RE的疗效目前尚不明确，针灸治疗RE的相关研究亟需统一疗效标准，提高研究质量，未来仍需要更多高质量随机对照试验来验证针灸治疗RE的效果。 

Systematic Evaluation of Acupuncture and Combined Therapies for Treating Reflux Esophagitis

OBJECTIVE To systematically evaluate the efficacy of acupuncture in reflux esophagitis (RE). METHODS Based on retrieving the clinical randomized controlled studies on acupuncture treatment of RE in CNKI， WANFANG， VIP， CBM， PubMed， Embase and Cochrane Library databases up to May 2019， the related literature was extracted and evaluated with Meta-analysis on Rev Man5.3. RESULTS A total of 13 studies with 1 120 patients were included. In terms of reducing the recurrence rate， acupuncture alone or combination of acupuncture and medicine was superior to Western medicine acupuncture alone: RR=0.21， 95%CI(0.05， 0.87); acupuncture + Liujun Shugan Decoction: RR=0.44， 95%CI(0.27， 0.71); acupuncture + Banxia Xiexin Decoction: RR=0.29， 95%CI(0.14， 0.60); acupuncture + Xuanfu Daizhe Decoction and Zuojin Pill: RR=0.40， 95%CI(0.26， 0.62); acupuncture + self-prescribed Chinese medicine + microwave hyperthermia: RR=0.24， 95%CI(0.08， 0.66)]. In terms of endoscopic efficiency， electroacupuncture combined with Western medicine was better than Western medicine aloneRR=1.23， 95%CI(1.06， 1.41)]. In terms of reducing the symptom scores， the combination of acupuncture and medicine was more effective than Western medicine acupuncture + Chinese medicine: RR=-1.73， 95%CI(-3.21， -0.25)， acupuncture + Chinese medicine + Western medicine: RR=-4.93， 95%CI(-5.52， -4.34)]. The adverse reactions of acupuncture combined with medicine were less than those of Western medicine alone.CONCLUSION In the treatment of RE， acupuncture combined with medicinal could obtain higher efficacy and lower recurrence while the efficacy of acupuncture alone is still unclear. Thus， there is an urgent need to standardize the efficacy of acupuncture in the treatment of RE and improve the quality of research. More high-quality randomized controlled trials are still needed in the future to validate the effectiveness of acupuncture for RE.