针刺治疗单纯性肥胖系统评价的再评价＊

目的 对针刺治疗单纯性肥胖的系统评价进行再评价研究,为针刺临床循证决策提供参考。方法 计算机检索主要的中英文电子文献数据库（PubMed、EMbase、The Cochrane Library、CBM、CNKI等）,收集自建库至2019年2月28日关于针刺干预单纯性肥胖的系统评价。本研究采用AMASTAR 2工具评价纳入系统评价的方法学质量,使用GRADE系统对纳入系统评价的结局指标进行证据质量分级。借助Stata 14.0软件进行统计分析。结果 共纳入11篇系统评价。AMSTAR 2评价结果显示,9篇为极低质量,2篇为低质量。存在问题最多的条目分别为实施前未确定研究方法、未提供排除文献清单及未考虑单个研究的偏倚风险。GRADE证据分级提示,34个结局指标为低或极低质量,5个结局指标为中等质量,无高级别证据。导致降级最主要的因素为局限性,其次为发表偏倚、不一致性。结论 当前针刺治疗单纯性肥胖患者的系统评价方法学质量不高,结局指标的可靠程度相对较低。因此,今后仍需开展高质量的随机对照试验来证实针刺治疗单纯性肥胖的疗效和安全性,并应规范针刺相关临床研究的方法学质量和报告质量,以期提高证据质量水平。

Acupuncture for Obesity: An Overview of Systematic Reviews

Objective To re-evaluate the systematic evaluation of acupuncture treatment for simple obesity, and provide reference for clinical evidence-based decision-making of acupuncture.Methods PubMed, EMbase, the Cochrane Library, CBM, CNKI, VIP and WanFang Data were electronically searched to collect systematic reviews evaluating acupuncture for obesity from inception to February 28th 2019. AMASTAR 2 tool was used to evaluate the methodological quality of the system evaluation, and GRADE system was used to classify the outcome indicators of the system evaluation. Statistical analysis was carried out with Stata 14.0 software.Results A total of 11 relevant SRs were included. The results of AMSTAR 2 show that the quality of 9 systematic reviews is extremely low, 2 quality grades are low. The most problematic items are the undetermined research method before implementation, the list of excluded studys not provided, and the risk of bias without considering individual studies. GRADE results showed that the quality of evidence of 34 outcomes was low or very low, and the quality of evidence of the five outcomes was medium. The most important factor leading to the degradation was the limitation, followed by publication bias and inconsistency.Conclusions The current evidence confirms the effectiveness of acupuncture for obesity; however, the methodological quality of the systematic review and the reliability of outcome measures are relatively low. Therefore, high-quality original research is needed to evaluate the efficacy and safety of acupuncture for simple obesity, and to standardize the methodological quality and reporting quality of acupuncture clinical research in order to improve the level of evidence.