针灸疗法与西药对照治疗围绝经期失眠症疗效和安全性的系统评价

【目的】系统评价针灸疗法与口服西药对照治疗围绝经期失眠症的临床疗效和安全性。【方法】计算机检索中国知网期刊全文数据库(CNKI)、维普期刊数据库(VIP)、万方数据知识服务平台(Wanfang)、PubMed、Web of Science、Cochrane Library等数据库。搜集并筛选相关的针灸疗法与西药对照治疗围绝经期失眠症疗效比较的随机对照研究,使用RevMan 5.3软件系统评价纳入研究的方法学和Meta分析。【结果】共纳入34项研究,其中,高质量研究14项,包含治疗组1459例及对照组1417例。本研究结果显示:针灸疗法治疗围绝经期失眠症总有效率OR=2.79,95%CI(2.22,3.50),P<0.00001]、匹兹堡睡眠质量指数量表评分MD=-2.09,95%CI(-2.91,-1.27),P<0.00001]、改良Kupperman评分方面MD=-4.41,95%CI(-6.38,-2.45),P<0.0001]均优于口服西药的对照组,差异有统计学意义;亚组分析结果提示,单纯针刺治疗总有效率高于对照组OR=2.57,95%CI(1.86,3.55),P<0.00001],差异有统计学意义。针灸疗法治疗的不良反应事件发生率低于对照组RR=0.32,95%CI(0.18,0.54),P<0.0001]。纳入文献存在发表性偏倚的可能。【结论】针灸疗法治疗围绝经期失眠症的临床疗效和安全性均高于口服西药,值得在临床推广。但由于纳入文献中低质量研究占多数,结论可信度一般,此结果有待于更多高质量的随机对照试验研究进行考证。

Systematic Evaluation of Therapeutic Efficacy and Safety of Acupuncture-Moxibustion Therapy in Comparison with Western Medicine for Treatment of Perimenopausal Insomnia

Objective To systematically evaluate the clinical therapeutic efficacy and safety of acupuncturemoxibustion therapy in comparison with western medicine for the treatment of perimenopausal insomnia.Methods We searched CNKI,VIP,Wanfang,PubMed,Web of Science,Cochrane Library databases by computer to collect and screen out the literatures on related randomized controlled trials about acupuncture therapy for perimenopausal insomnia,and used RevMan 5.3 software to carry out methodological quality evaluation and metaanalysis of the included literatures.Results A total of 34 researches were included,in which 14 were of high quality,including 1459 patients in the treatment group and 1417 patients in the control group.The results showed that the improvement in total effective rateOR=2.79,95%CI(2.22,3.50),P<0.00001],Pittsburgh Sleep Quality Index(PSQI)scoreMD=-2.09,95%CI(-2.91,-1.27),P<0.00001]and modified Kupperman scoreMD=-4.41,95%CI(-6.38,-2.45),P<0.00001]of the treatment group was superior to that of the control group.The results of subgroup analysis showed that the total effective rate in acupuncture alone group was significantly higher than that of the control groupOR=2.57,95%CI(1.86,3.55),P<0.00001].The incidence of adverse reactions for acupuncture-moxibustion therapy treatment was lower than the control groupRR=0.32,95%CI(0.18,0.54),P<0.0001].There were possible publication bias in the included literatures.Conclusion Acupuncture-moxibustion therapy has a better clinical efficacy and safety for perimenopausal insomnia than oral western medicine treatment.However,due to the low quality of the most included literatures,the conclusions are not particularly convinced,need to be verified by more randomized controlled trials with high quality.