针刺治疗早发性卵巢功能不全的系统评价和Meta分析

目的:分析与激素替代疗法(HRT)相比,针刺治疗早发性卵巢功能不全(POI)的临床疗效.方法:计算机检索中国知网(CNKI)、万方学术期刊全文数据库(Wanfang)、重庆维普数据库(CQVIP)、中国生物医学文献数据库(CBM)、科学网、Cochrane图书馆、PubMed及荷兰医学文摘(EMBASE)数据库,收集发表于2019年1月31日前的针刺治疗POI的随机对照试验(RCTs).主要疗效指标为血清基础促卵泡生成素(FSH)水平;次要指标包括血清黄体生成素(LH)、雌二醇(E2)和抗缪勒管激素(AMH)水平.两名作者独立提取数据,使用Cochrane评测工具评估偏倚和文献质量.采用RevMan 5.3对纳入文献进行Meta分析.结果:共纳入8篇RCTs,包含496例POI患者.Meta分析显示,与对照组相比,针刺可显著降低血清基础FSH水平[MD=-5.82,95%CI(-9.76,-1.87),I2=82%,P=0.004],升高E2水平[SMD=0.93,95%CI(0.34,1.52),I2=88%,P=0.002].亚组分析显示,与对照组相比,单纯针刺[MD=-4.53,95%CI(-8.96,-0.10),I2=73%,P=0.04]和针刺联合HRT[MD=-9.60,95%CI(-17.60,-1.61),I2=50%,P=0.02]均能显著降低FSH水平,但只有针刺联合HRT可显著升高E2水平[SMD=1.43,95%CI(1.03,1.82),I2=0%,P<0.00001].针刺与HRT之间LH水平无明显变化[MD=-3.16,95%CI(-9.41,3.10),I2=0%,P=0.32],纳入文献中只有1篇报告了AMH,结果显示针刺和HRT对AMH的改善无显著差异.结论:针刺可显著降低POI患者血清FSH水平,升高E2水平.然而,由于纳入文献存在样本量小、研究方法存在缺陷及显著的异质性等问题,支持研究结论的证据有限.因此,本研究结论仍需高质量的RCT加以验证.     

针刺治疗慢性鼻窦炎及术后疼痛的网状Meta分析

BackgroundThe network meta-analysis system was used to evaluate the efficacy of various acupuncture and moxibustion techniques for chronic rhinosinusitis (CRS) and related postoperative pain.MethodsAn electronic search of PubMed, Embase, Web of Science, Cochrane Library, OVID(the Offshore Vessel Inspection Database), CNKI, Wanfang, VIP, and CBM databases was conducted to identify randomised controlled trials on acupuncture and moxibustion for CRS and related postoperative pain from database inception to February 2021.The study included randomised controlled trials (RCTs) published in China and other countries in languages limited to Chinese and English. Primary studies included treated individuals without limitations on age, gender, or nationality and diagnosed as CRS. The total effective rate, visual analogue scale (VAS) score, and symptom and sign score were the primary outcomes. Evidence quality and risk-of-bias were determined. Network meta-analysis was performed.ResultsNineteen articles were included, involving 11 types of intervention measures. The pairwise comparisons showed that both acupuncture therapy combined with drugs (ATD) and sphenopalatine ganglion acupuncture combined with drugs (SGAD) were superior to western medicine (WM) in improving the total effective rate, and ATD was superior to manual acupuncture therapy (MAT), WM, and placebo (PL). In reducing the VAS score, both ATD and SGAD were superior to WM. Point-through-point acupuncture combined with pricking blood therapy (PABT) was superior to MAT. In reducing symptom and sign score, ATD was superior to WM and PL. PABT was superior to MAT. The results of network meta-analysis showed that ATD was superior to MAT, Traditional Chinese medicine (TCM), and WM in improving the total effective rate. In reducing the symptom and sign score, ATD was superior to PL, WM, MAT, and sham acupuncture (SA). PL was superior to MAT, WM, and SA. and PABT was superior to MAT and SA, MAT was superior to WM. There was no significant difference between the intervention measures in reducing the VAS score. The surface under the cumulative ranking curve showed that ATD had the best effect in improving the total effective rate and reducing the VAS and symptom and sign score.ConclusionATD was the best method for improving the total effective rate and reducing the VAS and symptom and sign score in the treatment of CRS and related postoperative pain. However, considering the current study quantity and quality, multicentre and high-quality clinical studies with larger sample sizes are needed to verify our findings.Trial registrationInternational Prospective Register of Systematic Reviews(CRD42021246103).     

Acupuncture for obesity: a systematic review

Obesity has become a major health challenge for both patients and family physicians. Well-known methods of weight reduction such as diet and exercise are often difficult to comply with due to lifestyle and quality of life issues. Other methods such as diet pills or surgery have potentially serious side effects and often do not show long-term benefit. In an attempt to find a less invasive and effective modality of treatment, traditional Chinese medicine, particularly acupuncture and auriculotherapy, has become a topic of research in this field. The authors conducted a review of the current evidence regarding the use of auricular and body acupuncture in the treatment of obesity from their beginning to June 2014. Any published trial using randomized assignment to the intervention and control groups, in full text were included. Overall, moderate evidence in favor of acupuncture over exercise in the treatment of obesity was found. However, due to the limitations of the published studies in this field, it is necessary to conduct a large high quality randomized controlled trial in order to determine whether acupuncture should be used as a treatment modality to achieve weight loss in obese individuals.     

Filiform needle acupuncture for allergic rhinitis: A systematic review and meta-analysis

Background: Filiform needle acupuncture(FNA), the most classical and widely applied acupuncture method based on traditional Chinese medicine theory, has shown a promising effect in the treatment of allergic rhinitis(AR).Objective: To evaluate the efficacy, safety, cost-effectiveness, and patient preference of FNA in the treatment of AR by comparing FNA with sham acupuncture, no treatment, and conventional medication.Search strategy: Eight electronic databases were systematically searched from in...     

Acupuncture therapy for angina pectoris: a systematic review

Objective

To assess the effectiveness and safety of acupuncture therapy for angina pectoris.

Methods

Randomized controlled trials (RCTs) concerned with acupuncture treatment of angina pectoris were identified by searching Academic Source Premier, MEDLINE, Science Citation Index Expanded, and three Chinese databases (China biology medicine database, China national knowledge infrastructure, and VIP database for Chinese technical periodicals). The valid data were extracted in accordance with our inclusion and exclusion criteria. The main outcomes of the included studies were synthesized using Revman 5.1.

Results

Twenty-one articles on 16 individual studies were included and evaluated as having high or moderate risk of bias according to the standards of the Cochrane Collaboration. Meta-analysis indicated that acupuncture combined with conventional drugs (ACCD) was superior to conventional drugs alone in reducing the incidence of acute myocardial infarction (AMI) [OR=0.18, 95% CI (0.04, 0.84), P=0.03]. Moreover, ACCD was superior to conventional drugs in the relief of angina symptoms [OR=4.23, 95% CI (2.73, 6.56), P<0.00001], and improvement of electrocardiography (ECG) [OR=2.61, 95% CI (1.83, 3.73), P<0.00001]. Acupuncture by itself was also superior to conventional drugs for angina symptoms [OR=3.59, 95%C/(1.76, 7.92), P=0.0004] and ECG improvement [OR=3.07, 95%CI (1.54, 6.10), P=0.001]. ACCD was superior to conventional drugs in shortening the time to onset of angina relief [WMD=−1.40, 95% CI (−1.65, −1.15), P< 0.00001]. However, the time to onset was significantly longer for acupuncture treatment than for conventional treatment alone [WMD=2.43, 95% CI (1.63, 3.23), P<0.000 01].

Conclusion

ACCD reduced the occurrence of AMI, and both acupuncture and ACCD relieved angina symptoms and improved ECG. However, compared with conventional treatment, acupuncture showed a longer delay before its onset of action. This indicates that acupuncture is not suitable for emergency treatment of heart attack. Owing to the poor quality of the current evidence, the findings of this systematic review need to be verified by more RCTs to enhance statistical power.     

Cupping therapy for patients with chronic urticaria: A systematic review and meta-analysis

BackgroundChronic urticaria (CU) is a common skin disease, which has a negative effect on quality of life. Current treatments do not fully control the symptoms of urticaria for many CU patients, thus effective and safe treatments for CU are still needed.ObjectiveThis review aims to evaluate the effectiveness and safety of cupping therapy in patients with CU.Search strategyThe search strategy looked for the presence of related keywords, such as “chronic urticaria” and “cupping therapy,” in the title and abstract of research articles indexed in major databases. Randomized controlled trials (RCTs) were selected after querying nine electronic databases from their inception to May 2019 with the above search terms.Inclusion criteriaRCTs were included if they recruited patients with CU who were intervened with dry or wet cupping. Publications could be written in Chinese or English.Data extraction and analysisData were extracted, and the studies were assessed for the quality of their methodological design and risk of bias. Meta-analyses of the RCT data were conducted to assess the total effective rate of the treatment as the primary outcome. Skin disease quality of life index score, recurrence rate, and adverse events were assessed as secondary outcomes. Subgroup analyses were conducted based on different interventions.ResultsThirteen comparisons from 12 RCTs involving 842 participants were included. There were no significant differences between wet cupping and medications in total effective rate (n = 372; risk ratio [RR] = 1.10, 95% confidence interval [CI] 0.97 to 1.25; P = 0.14) or recurrence rate (n = 240; RR = 0.56, 95% CI 0.23 to 1.36; P = 0.20). Cupping therapy, in combination with antihistamine treatment was more efficacious than antihistamines alone, with a greater total effective rate (n = 342; RR = 1.18, 95% CI 1.01 to 1.39; P = 0.03) and lower recurrence rate (n = 342; RR = 0.52, 95% CI 0.32 to 0.84; P = 0.007). Cupping therapy combined with acupuncture was more effective than acupuncture alone (n = 156; RR = 1.25, 95% CI 1.07 to 1.46; P = 0.006). No serious adverse events were reported.ConclusionWet cupping may be as effective as treatment with antihistamines. When cupping therapy is used as an adjuvant therapy to antihistamines or acupuncture, it may enhance the efficacy. Results drawn from these studies should be interpreted with caution and applied with care to clinical practice, because of the poor quality among the studies that were reviewed.Systematic review registrationPROSPERO, CRD42019137451.     

Acupuncture for allergic rhinitis: a systematic review and meta analysis

Objective

To analyze and review the clinical efficacy of acupuncture (including electroacupuncture) alone for allergic rhinitis (AR) and to compare its efficacy with antihistamines and Chinese patent medicine Bi Yan Kang Tablet.

Methods

The search strategy, inclusion and exclusion criteria were made according to the principle of evidence-based medicine. We performed a systematic search on China National Knowledge Infrastructure (CNKI), Wanfang Academic Journal Full-text Database (Wanfang), Chongqing VIP Database (CQVIP), Chinese Biomedical Literature Database (CBM), PubMed, Excerpta Medica Database (EMBASE), Web of Science, Cochrane Library, and Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) of acupuncture for allergic rhinitis between January 1990 and December 2015. The quality was evaluated by Cochrane Handbook for Systematic Reviews of Interventions Version 5.1, and the meta-analysis was conducted by RevMan 5.3 version.

Results

Twenty eligible RCTs were included into the meta-analysis after selection. Compared with antihistamines, the meta-analysis showed RR=1.24>1, 95%CI[1.15, 1.33], P<0.00001, indicating that acupuncture achieved a better total effective rate for AR than antihistamines; MD = –0.93<0, 95%CI[–1.22,–0.63], P<0.00001, indicating that acupuncture is better than antihistamines in decreasing the total nasal symptom score (TNSS) in AR patients; and MD = 1.46>0, 95%CI[–10.84, 13.75], P = 0.82, indicating that there was no statistical difference between acupuncture and antihistamines in regulating immunoglobulin E (IgE) in AR patients. Compared with Bi Yan Kang Tablet, the meta-analysis has shown RR = 1.50>1, 95%CI[1.30, 1.73], P<0.00001, indicating that acupuncture achieved a better total effective rate for AR than Chinese patent medicine Bi Yan Kang Tablet.

Conclusion

Acupuncture alone can achieve a better total effective rate for AR than antihistamines and Bi Yan Kang Tablet. It is also better than antihistamines in improving clinical symptom scores; however, whether acupuncture is better than Bi Yan Kang Tablet needs further proof. As far as current data are concerned, there was no statistical difference between acupuncture and antihistamines in improving serum IgE; further study is needed in this regard. The risk of bias due to absent randomization methods or blinding implementation decreased the evidence level of the overall conclusion.

     

Acupuncture and moxibustion for irritable bowel syndrome: An umbrella systematic review

Background: Irritable bowel syndrome(IBS) is a functional bowel disease characterized by abdominal pain or discomfort associated with altered bowel habits. Several clinical studies have demonstrated the effectiveness of acupuncture and moxibustion for IBS. Many systematic reviews of acupuncture and moxibustion for IBS have been published in recent years, but their results are not entirely consistent.Objective: To evaluate the methodological, reporting, and evidence quality of systematic reviews ...     

针灸与西药治疗前列腺增生症疗效比较的系统评价

目的:评价目前针灸治疗前列腺增生症相关文献的质量以及针灸与西药比较治疗前列腺增生症的临床疗效及其安全性。方法:检索PUBMED、Cohrance图书馆、CBM数据库、CNKI数据库等收集针灸与西药比较治疗前列腺增生症的临床随机或半随机对照试验,选择符合纳入标准的临床试验并由两名评价者独立进行数据的提取。以Cochrane系统评价手册4.2.6进行质量评价,统计学分析采用RevMan4.2.8。结果:共纳入6个随机或半随机对照试验(共546例)。6项研究采用总有效率为评价指标,Meta-分析显示针灸治疗前列腺增生症对照西药,组间比较差异有统计学意义[合并RR(固定效应模型)=1.26,95%CI(1.15,1.37),Z=5.13,P0.00001]。3项研究采用治愈率为评价指标,Meta-分析显示针灸治疗前列腺增生症对照西药,组间比较差异有统计学意义[合并RR(固定效应模型)=4.53,95%CI(2.16,9.50),Z=4.00,P0.0001]。结论:针灸治疗前列腺增生症安全、有效,对照西药可能有一定优势,但因纳入文献数量有限且质量较低,结论尚不确定,需高质量随机双盲对照试验来进一步验证。     

针灸治疗糖尿病周围神经病变的meta分析

目的:系统评价针灸治疗糖尿病周围神经病变(DPN)的疗效。方法:对针灸治疗糖尿病周围神经病变的随机对照试验进行系统评价,数据采用专用软件RevMan4.2版进行统计分析。结果:10篇研究共696例患者满足纳入标准,Meta分析结果显示,针灸治疗DPN的有效率优于对照组(P<0.00001)。针灸对DPN神经传导速度的改善亦优于对照组(运动神经传导速度P<0.00001,感觉神经传导速度P=0.0005或P<0.00001)。结论:本系统评价结果说明,较之西药治疗,针灸对糖尿病周围神经病变症状、体征及神经传导速度均有较好疗效。但由于试验方法学质量较低,尚不能充分肯定,需高质量的试验进一步证实。     

Chinese herbal medicine for COVID-19: Current evidence with systematic review and meta-analysis

BackgroundThere is currently no drug or therapy that cures COVID-19, a highly contagious and life-threatening disease.ObjectiveThis systematic review and meta-analysis summarized contemporary studies that report the use of Chinese herbal medicine (CHM) to treat COVID-19.Search strategySix electronic databases (PubMed/MEDLINE, Cochrane Library, ScienceDirect, Google Scholar, Wanfang Data and China National Knowledge Infrastructure) were searched from their beginning to May 15, 2020 with the following search terms: traditional Chinese medicine, Chinese medicine, Chinese herbal medicine, COVID-19, new coronavirus pneumonia, SARS-CoV-2, and randomized controlled trial.Inclusion criteriaRandomized controlled trials (RCTs) from peer-reviewed journals and non-reviewed publications were included. Further, included RCTs had a control group that was given standard care (SC; such as conventional Western medicine treatments or routine medical care), and a treatment group that was given SC plus CHM.Data extraction and analysisTwo evaluators screened and collected literature independently; information on participants, study design, interventions, follow-up and adverse events were extracted, and risk of bias was assessed. The primary outcomes included scores that represented changes in symptoms and signs over the course of treatment. Secondary outcomes included the level of inflammatory markers, improvement of pneumonia confirmed by computed tomography (CT), and adverse events. Dichotomous data were expressed as risk ratio or hazard ratio with 95% confidence interval (CI); where time-to-event analysis was used, outcomes were expressed as odds ratio with 95% CI. Continuous data were expressed as difference in means (MD) with 95% CI, and standardized mean difference (SMD) was used when different outcome scales were pooled.ResultsSeven original studies, comprising a total of 732 adults, were included in this meta-analysis. Compared to SC alone, CHM plus SC had a superior effect on the change of symptom and sign score (−1.30 by SMD, 95% CI [−2.43, −0.16]; 3 studies; n = 261, P = 0.03), on inflammatory marker C-reactive protein (CRP, mg/L; −11.82 by MD, 95% CI [−17.95, −5.69]; 5 studies; n = 325, P = 0.0002), on number of patients with improved lung CT scans (1.34 by risk ratio, 95% CI [1.19, 1.51]; 4 studies; n = 489, P < 0.00001). No significant adverse events were recorded in the included RCTs.ConclusionCurrent evidence shows that CHM, as an adjunct treatment with standard care, helps to improve treatment outcomes in COVID-19 cases.     

针刀与关节腔注射玻璃酸钠治疗膝骨关节炎疗效比较的系统评价和Meta分析

目的:评价针刀治疗膝骨关节炎的有效性和安全性。方法:计算机检索中国知网(CNKI)、维普数据库(VIP)、万方数据库(Wanfang Data)、PubMed和Cochrane临床对照试验中心注册库(2011年第3期),所有数据库检索时间从建库到2011年9月15日。纳入治疗组采用针刀疗法、对照组采用关节腔注射玻璃酸钠的随机对照试验,由2名评价者独立提取资料和评价文献质量后采用RevMan 5.1软件进行Meta分析。结果:共纳入6个随机对照试验,涉及429例患者。Meta分析结果显示针刀治疗膝骨关节炎的近期总有效率和治愈率均优于关节腔注射玻璃酸钠,其合并的OR值及95%CI分别为:OR=2.18,95%CI[1.17,4.06];OR=1.86,95%CI[1.21,2.85]。结论:针刀治疗膝骨关节炎近期疗效优于关节腔注射玻璃酸钠。但纳入试验方法学质量不高,且均未报道不良事件,建议开展高质量的随机对照试验加以验证。     

Chinese herbal medicine in treatment of diabetic peripheral neuropathy: A systematic review and meta-analysis

Ethnopharmacological relevance

To investigate the influence of paeoniflorin (major bioactive component of Paeonia lactiflora Pall.) on the pharmacokinetic behavior of aconitine (major toxic and bioactive component of Aconitum carmichaeli Debx.) and potential detoxifying effect of paeoniflorin on the acute toxicity of aconitine, which may provide in depth understanding to the toxicity reduction effect of Paeonia lactiflora to Aconitum carmichaeli.

Materials and methods

Ultra high performance liquid chromatography coupled with triple quadrupole mass spectrometer (UHPLC–MS/MS) was employed to determine the plasma content of aconitine. Aconitine was administrated by oral to SD rats at the dosage of 200 μg/kg with or without paeoniflorin given by intraperitoneal injection at the dosage of 20 mg/kg. Plasma samples were collected for determination and analysis of pharmacokinetic parameters of aconitine. The LD₅₀ of aconitine and acute animal death induced by aconitine were examined when aconitine was given alone or jointly with paeoniflorin in ICR mice.

Results

A sensitive, accurate, precise, reliable and repeatable UHPLC–MS/MS method was successfully established for determination of the plasma content of aconitine in 12.5 μL plasma sample. The lower limit of quantification of aconitine was 0.01 ng/mL. Compared with the SD rats that were orally administrated with aconitine alone, the rats received aconitine and co-administrated with paeoniflorin by peritoneal injection showed a remarkably lower C_max (5.69 ng/mL vs 9.66 ng/mL, P < 0.05) and delayed T_max (70 min vs 46 min, P < 0.05), as well as a trend of reduction in AUC_0–t (1082.75 ng-min/mL vs 1650.27 ng-min/mL, P = 0.395). The LD₅₀ values of aconitine coadministered with 120 or 240 mg/kg of paeoniflorin were obviously increased to 2.30 and 2.15 mg/kg against 1.80 mg/kg of aconitine by oral administration alone. Mice treated with paeoniflorin (240 mg/kg) and aconitine (1.8 mg/kg) together revealed a significant decreased death rate than that received aconitine treatment alone (15% vs 50%, P < 0.05).

Conclusions

The acute oral toxicity of aconitine in rats was significantly reduced by paeoniflorin; this might result from the alterations of pharmacokinetic behavior of aconitine in the animals by coadministration of paeoniflorin.     

Chinese herbal medicine in treatment of diabetic peripheral neuropathy: A systematic review and meta-analysis

Aim of study

There are multimodal and multidisciplinary approaches to treat diabetic peripheral neuropathy (DPN). However, the intractable adverse effects limited their widespread use. Chinese herbal medicine (CHM) is increasingly used for the treatment of DPN. The aim of this study was to review existing evidence on the effectiveness of CHM for the treatment of DPN.

Materials and methods

Searches were performed with Medline, Embase, Cochrane Central Register of Controlled Trials, CNKI, CBM and Wangfan databases. Controlled trials comparing CHM with other medicine for the treatment of DPN were analyzed.

Results

Eighteen trials met the inclusion criteria. All trials used vitamin B12 and/or B1 as control. Clinical therapeutic effect, divided by three grades including marked effective, effective and ineffective according to the improved degree of subjective symptom, tendon reflex, and nerve conduction velocity, was the only end point reported in all trials, and thus evaluated. The results showed CHM treatment was associated with a superiority in marked effective (odds ratio [OR], 2.40; 95% confidence interval [CI]: 0.94 to 2.97; p<0.001), and effective (OR, 1.39; 95% CI: 1.16 to 1.67; p<0.001). Patients who received CHM treatment was associated with a less likely to report ineffective (OR, 0.26; 95% CI: 0.21 to 0.33, p<0.001). No adverse events were reported in any of the included trials.

Conclusions

According to the pooled results of our study and the poor quality of the included trials, it might be uncertainty that there was a superiority of CHM for treating DPN. More rigorous controlled trials are required to substantiate or refute these early findings.     

Traditional Chinese medicine for acute mountain sickness prevention:A systematic review and meta-analysis of randomized controlled trialsOA

Objective: To evaluate the efficacy of traditional Chinese medicine(TCM) for preventing acute mountain sickness(AMS).Methods: We included randomized controlled trials(RCTs) which evalueded the effect of TCM for preventing AMS, compared with a placebo, no treatment or acetazolamide. The literature was searched in 6major databases. RevMan 5.4 software was used for the meta-analysis. The relative risk for discrete variables and the mean difference for continuous variables with 95% confidence interv...     

喜炎平注射液不良反应的Meta分析

目的:采用Meta分析的方法,对喜炎平注射液临床使用中不良反应的发生率进行研究,以评价其在临床应用中的安全性和疗效。方法:由2位研究者分别独立检索中国知网、万方数据库、维普数据库、Web of Knowledge、Pub Med、Elsevier Science Direct电子期刊等数据库(1950年1月至2016年4月)中与喜炎平注射液不良反应有关的临床研究文献。根据制定的纳入标准以及排除标准收集数据,提取信息并交叉核对筛选。用Rev Man5.3软件对筛选后数据进行Meta分析。结果:共有73篇文献共8485例患者纳入研究,喜炎平注射液组不良反应发生率(4.3%)低于对照组(8.9%)。喜炎平注射液组与对照组不良反应发生率的比值比OR值为0.46,95%CI[0.38,0.55],P0.00001,结果呈显著性差异。在疗效的考察上,除热毒宁外,有效率均高于对照组。结论:喜炎平注射液的有效性和安全性相对较好,但临床使用中应密切注视其引发的严重过敏反应。不排除失访偏倚和发表偏倚对结果的影响。喜炎平注射液不良反应研究的文献质量有待进一步提高,确保是随机双盲临床对照研究。     

Efficacy of fire-needle for acne: a systematic review and meta-analysis of randomized controlled trials

Objective

To evaluate the efficacy of fire-needle therapy for acne to provide an objective basis for clinical decisions.