腕踝针治疗疼痛类疾病临床疗效的系统评价

目的评价腕踝针治疗常见痛症的临床疗效。方法检索PubMed（1966--2010）、Embase（1980--2010）、CochraneLibrary（Issue2，2010）、中国知网（CNKI，1979--2010）、维普期刊数据库（VIP，1989—2010）、万方数字化期刊群（WF，1998--2010），选择符合纳入标准（半）随机对照试验；采用RevMan5．0．20软件统计腕踝针治疗肩疼痛、癌性疼痛、腰疼痛、偏头痛的疗效指标，并对治疗带状疱疹、骨痹、偏瘫性肩疼痛的疗效指标予以描述性评价。结果有21篇文献纳入研究，肩疼痛：2项研究采用西药对照，RR=1．50，95％CI（1．27，1．78），Z=4．67，P〈0．00001，提示腕踝针治疗肩疼痛疗效优于西药治疗；6项研究为腕踝针综合疗法对照常规针刺，研究存在异质性，RR=1．07，95％cI（o．99，1．16），z=1．79，P=0．07，提示腕踝针综合疗法治疗肩疼痛疗效优于针刺治疗证据不足。癌性疼痛：3篇文献存在异质性，RR=1．15，95％CI（1．03，1．28），Z=2．43，P=0．02，腕踝针治疗癌性疼痛疗效优于西药缺乏强有力的证据。腰疼痛：3项研究RR=1．13，95％cI（1．04，1．23），Z=2．91，P=0．042，提示腕躁针综合疗法治疗腰疼痛疗效优于单纯针刺。1项B级证据表明腕踝针配合三棱针点刺放血治疗带状疱疹疗效优于药物组，且中期疗效好；4项C级证据表明腕踝针在治疗偏头痛、骨痹、偏瘫性肩疼痛优势明显；1项C级证据表明腕踝针治疗疼痛类疾病疗效优于麻木类疾病。结论本研究纳入研究质量偏低，且主观分类难免有疏漏，故腕踝针治疗疼痛类疾病的有效性，尚缺乏足够的证据，有待进一步研究来验证。

Systematic review on clinical efficacy of Wrist - ankle acupuncture therapy for pain syndrome

Objective To assess the efficacy of wrist - ankle ＇acupuncture treatment for the pain syndrome. Methods PubMed database （ 1966--2010）, Embase database （ 1986--2010）, Cochrane Library （--2010）, Chi- na HowNet database （ 1979--2010）, VIP Journals Database （ 1989--2010）, and Wanfang database （1998--2010） were retrieved. Randomized or quasi - randomized controlled studies were included. The priority was given to high - quality randomized, controlled trials. Statistical outcome indicators of shoulder pain, cancer pain, waist pain and mi- graine were measured using RevMan5. 0.20 software. Indicators of herpes zoster, bone weakness and hemiplegic shoulder pain were measured using described evaluation. Results A total of 21 articles were included. Shoulder pain：Meta- analysis showed significant differences between the acupuncture therapy and Western medicine therapy （ RR = 1.50, 95% CI （ 1.27,1.78）, Z = 4.67, P 〈 0.00001 ）, indicating an obvious superior effect of the wrist - ankle acupuncture therapy; significant difference and heterogeneity also existed between the 6 comprehensive acu- puncture therapy and acupuncture monotherapy and （ RR = 1.07, 95% CI （0.99,1.16）, Z = 1.79, P = 0. 07 ）, wrist - ankle acupuncture efficacy of shoulder pain still lacks clinical evidence. Cancer pain ：3 studies existed hetero- geneity, （ RR = 1.15, 95 % CI （ 1.03, 1.28 ）, Z = 2.43, P = 0.02）, therefore obvious superior efficacy of wrist - ankle acupuncture for cancer pain still lacks clinical evidence. Waist pain：3 studies RR = 1. 13,95% CI （ 1.04,1.23）, Z = 2.91, P = 0. 042, indicating a better effect of comprehensive wrist - ankle acupuncture therapy, as compared to the conventional body acupuncture monothera- py. one with Cochrane B level showed the following：wrist -ankle acupuncture with three - edged needle prick blood in the treatment of herpes zoster and the medium - term effi- cacy, which was superior to the drug group; Four C - level evidence study demonstrated that wrist - ankle acupunc- ture improved migraine, bone weakness, and hemiplegie shoulder pain One C - level evidence study revealed that wrist - ankle acupuncture has more effective efficacy in the treatment of pain diseases than numbness diseases. Con- clusion The inclusion of limited and low quality clinical studies has verified the efiqcacy of wrist - ankle acupunc- ture in the treatment of pain syndrome, and most clinical studies have small sample sizes. Large sample size, ran- domized, controlled trials are needed in the future for more definitive Results.