Martin J, Donaldson A N A, Villarroel R, Parmar M K B, Ernst E, Higginson I J
Eur Respir J. 2002 Oct;20(4):846-52. doi: 10.1183/09031936.02.00078702.
Contradictory results from randomised controlled trials of acupuncture in asthma suggest both a beneficial and detrimental effect. The authors conducted a formal systematic review and meta-analysis of all randomised clinical trials in the published literature that have compared acupuncture at real and placebo points in asthma patients. The authors searched for trials published in the period 1970-2000. Trials had to measure at least one of the following objective outcomes: peak expiratory flow rate, forced expiratory volume in one second (FEV1) and forced vital capacity. Estimates of the standarised mean difference, between acupuncture and placebo were computed for each trial and combined to estimate the overall effect. Hetereogeneity was investigated in terms of the characteristics of the individual studies. Twelve trials met the inclusion criteria but data from one could not be obtained. Individual patient data were available in only three. Standardised differences between means ranging from 0.071 to 0.133, in favour of acupuncture, were obtained. The overall effect was not conventionally significant and it corresponds to an approximate difference in FEV1 means of 1.7. After exploring hetereogenenity, it was found that studies where bronchoconstriction was induced during the experiment showed a conventionally significant effect. This meta-analysis did not find evidence of an effect of acupuncture in reducing asthma. However, the meta-analysis was limited by shortcomings of the individual trials, in terms of sample size, missing information, adjustment of baseline characteristics and a possible bias against acupuncture introduced by the use of placebo points that may not be completely inactive. There was a suggestion of preferential publication of trials in favour of acupuncture. There is an obvious need to conduct a full-scale randomised clinical trial addressing these limitations and the prognostic value of the aetiology of the disease.
针灸治疗哮喘的随机对照试验结果相互矛盾，表明其既有有益效果，也有有害效果。作者对已发表文献中所有比较哮喘患者真实穴位针刺与安慰剂穴位针刺的随机临床试验进行了正式的系统评价和荟萃分析。作者检索了1970年至2000年期间发表的试验。试验必须测量以下至少一项客观指标：呼气峰值流速、一秒用力呼气容积（FEV1）和用力肺活量。计算每个试验中针刺组与安慰剂组之间的标准化平均差估计值，并合并以估计总体效果。根据各个研究的特征对异质性进行了调查。12项试验符合纳入标准，但其中1项的数据无法获得。仅3项试验有个体患者数据。获得的均值标准化差异范围为0.071至0.133，支持针刺治疗。总体效果在传统意义上不显著，相当于FEV1均值的近似差异为1.7。在探索异质性后发现，在实验过程中诱发支气管收缩的研究显示出传统意义上的显著效果。这项荟萃分析未发现针刺治疗哮喘有效果的证据。然而，荟萃分析受到各个试验的缺点限制，包括样本量、信息缺失、基线特征调整以及使用可能并非完全无活性的安慰剂穴位可能对针刺治疗产生的潜在偏倚。有迹象表明，支持针刺治疗的试验存在优先发表的情况。显然有必要进行一项全面的随机临床试验，以解决这些局限性以及疾病病因的预后价值问题。
