近十年针刺治疗腰痛的国内外指南与临床研究现状分析

目的了解针刺治疗腰痛在国内外相关指南中的推荐情况及临床研究现状,为开展针刺临床研究和积累临床证据提供思路与方法。方法检索Medline、EMBASE、Cochrane library、中国知网、Sinomed、维普、万方及中国临床指南文库、英国国家临床优化研究所(NICE)、美国国家指南库(NGC)、苏格兰校际指南网络(SIGN)、新西兰指南研究组(NZGG)、加拿大医学会临床指南库(CMACPG)、国际指南网络(GIN),分析2008年10月至2018年10月间发表的腰痛的指南中针刺的推荐情况和针刺治疗腰痛的临床试验的研究目的、主要对照干预措施和临床结局指标选取情况,并对纳入分析的指南及临床研究的实用性及差异进行分析。结果共纳入国外指南13份,临床研究文献92篇;国内指南4份,临床研究文献379篇。国外腰痛指南仅做了针刺推荐,较少有推荐级别和具体针刺方案,临床指导意义欠缺;国内指南针对不同腰痛类别给出了详细针刺推荐级别和具体的针刺选穴、操作、疗程方案等,更加实用。国内外针刺治疗腰痛的临床试验在研究目的、方法学、报告的规范性等层面差异较大,目前的临床研究存在样本量少、随访时间短等不足,积累的临床证据与临床实际存在差距的问题。结论目前针刺治疗腰痛临床证据和指南推荐与临床实际存在一定偏差,亟需高质量的RCT证据和真实世界的临床研究证据来促进实用性指南的建立。

Status Analysis of Clinical Research and Guidelines of Acupuncture Treatment for Low Back Pain in Recent 10 Years

Objective To understand the recommendation and clinical research status of acupuncture in the guidelines of low back pain at home and abroad,and provide ideas and methods for conducting clinical research and accumulating clinical evidence for acupuncture. Methods The Medline,EMBASE,the Cochrane library,China National Knowledge Infrastructure ( CNKI),Sinomed,VIP database,Wanfang Data and China Guideline Clearinghouse, National Institute for Clinical excellence ( NICE),National Guideline Clearinghouse ( NGC),Scottish Intercollegiate Guidelines Network ( SIGN),New Zealand Guideline Group ( NZGG),Canadian Medical Association Clinical Practice Guidelines Database ( CMACPG),Guidelines International Network ( GIN) were retrieved,and the recommendations of acupuncture in the guidelines for low back pain published from October 2008 to October 2018 and the clinical purpose of acupuncture treatment for low back pain,the main control interventions and the selection of clinical outcome indicators were analyzed,and the practicality and differences of the guidelines and clinical researches for inclusion were analyzed. Results A total of 13 foreign guidelines and 4 domestic guidelines were obtained,and 92 foreign clinical studies and 379 domestic clinical studies were included. Foreign guidelines on lumbago only recommend acupuncture,but few recommend levels and specific acupuncture programs,which lack clinical significance. The domestic guidelines are more practical and provide detailed recommendation levels and specific acupuncture point selection,operation and treatment programs for different types of lumbago. The clinical trials of acupuncture for the treatment of low back pain at home and abroad vary greatly in aspects of research objectives,selection of outcome indicators, and standardization of clinical research reports. The current clinical research had shortcomings such as small sample size and short follow-up time,and the accumulated clinical evidence and clinical reality are different. Conclusion At present,the clinical evidence and guidelines for acupuncture in the treatment of lumbago are deviated from the actual clinical practice to some degree,and high-quality RCT and real-world clinical research evidence are urgently needed in the treatment of lumbago,to facilitate the establishment of practical guidelines.