针刺治疗单纯性肥胖症临床疗效比较的系统评价

目的:评价针刺治疗单纯性肥胖的临床疗效,分析目前临床研究的现状.方法:电子检索PubMed(1979-2008年)、OVID(1979-2008年)、EBSCO(1973-2008年)、Cochrane图书馆(2008年第2期)、中国生物医学文献数据库(CBM,1978-2008年)、中国期刊全文数据库(CNKI,1979-2008年)、维普期刊数据库(VIP,1989-2008年)、万方数据库(1998-2008年),同时筛选纳入研究的参考文献,收集针刺治疗单纯性肥胖的临床随机对照试验,由两名评价员独立评价文献质量,并采用RevMan 4.2.8软件对纳入研究结果进行Meta分析.结果:8篇文献符合纳入标准,共1 017例患者.Meta分析显示针刺对照西药治疗,有效率的组间比较差异有统计学意义合并RR(固定效应模型)=1.11,95%CI(1.05,1.18),P=0.000 6];针刺对照西布曲明治疗,体质量的组间比较差异有统计学意义合并WMD(固定效应模型)=1.94,95%CI(1.73,2.16),P＜0.000 01];体质量指数的组间比较差异有统计学意义合并WMD(固定效应模型)=0.52,95%CI(0.33,0.70),P＜0.000 01];但针刺在臀围改善方面不及西布曲明合并WMD(固定效应模型)=-0.35,95%CI(-0.56,-0.15),P＜0.000 7,].结论:合理饮食和适当运动基础上,针刺治疗单纯性肥胖安全、有效,可能优于常规西药.因纳入文献数量有限且部分质量较低,需更多高质量随机对照研究来进一步验证.

Systematic evaluation of therapeutic effect of acupuncture for treatment of simple obesity

Objective To evaluate the therapeutic effect of acupuncture for treatment of simple obesity, and to analyze the current situation of clinical studies. Methods Randomized controlled trials (RCTs) involving acupuncture treatment for simple obesity were searched from PubMed (1979-2008), OVID (1979 - 2008), EBSCO (1973 -2008), Cochrane Library (Issue 2, 2008), CBM (1978-2008), CNKK1979 - 2008), VIP (1989-2008) and WanFang Database (1998 - 2008). Literatures were enrolled focusing on RCTs related to acupuncture treatment for simple obesity; the quality of literatures were evaluated by two evaluators unaidedly. Meta-analyses were conducted with the Cochrane Collaboration's RevMan 4.2.8 software. Results Eight papers including 1 017 cases, conformed with the enrolled criteria. Meta-analyses showed that there were significant difference between acupuncture groups and western medicine groups in the effective rate combined RR (fixed effects model) = 1.11, 95% CI (1.05, 1.18) ,P= 0.000 6]. There was a significant difference between acupuncture and Sibutramine in the body mass combined WMD (fixed effects model) = 1.94, 95%CI(1.73, 2.16) ,P<0.000 01] and body mass index (BMI) combined WMD (fixed effects model) = 0.52,95%CI(0.33,0.70) ,P<0.000 01]. However, acupuncture was not superior to Sibutramine in hip circumference ( HO combined WMD (fixed effects model)= - 0.35,95%CI ( - 0.56,-0.15),P<0.000 7]. Conclusion For treating simple obesity, besides reasonable diet and exercise, acupuncture is safe and effective, which may be more effective than routine western medicine. The quantity of literature was limited and the quality of some literatures was low. Thus, more high-quality and large-scale of RCTs are needed.