针刺治疗失眠症的随机对照试验系统评价。
Acupuncture for treatment of insomnia: a systematic review of randomized controlled trials.
机构信息
Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
出版信息
J Altern Complement Med. 2009 Nov;15(11):1171-86. doi: 10.1089/acm.2009.0041.
BACKGROUND
Acupuncture is commonly used in treating insomnia in China, and clinical studies have shown that acupuncture may have a beneficial effect on insomnia compared with Western medication.
METHODS
We included randomized controlled trials on acupuncture for insomnia. We searched PubMed, the Cochrane Library (2008 Issue 3), China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wan Fang Database. All searches ended in December 2008. Two authors extracted data and assessed the trials' quality independently. RevMan 5.0.17 software was used for data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI).
RESULTS
Forty-six (46) randomized trials involving 3811 patients were included, and the methodological quality of trials was generally fair in terms of randomization, blinding, and intention-to-treat analysis. Meta-analyses showed a beneficial effect of acupuncture compared with no treatment (MD -3.28, 95% CI -6.10 to -0.46, p = 0.02; 4 trials) and real acupressure compared with sham acupressure (MD -2.94, 95% CI -5.77 to -0.11, p = 0.04; 2 trials) on total scores of Pittsburgh Sleep Quality Index. Acupuncture was superior to medications regarding the number of patients with total sleep duration increased for >3 hours (RR 1.53, 95% CI 1.24-1.88, p < 0.0001). However, there was no difference between acupuncture and medications in average sleep duration (MD -0.06, 95% CI -0.30-0.18, p = 0.63). Acupuncture plus medications showed better effect than medications alone on total sleep duration (MD 1.09, 95% CI 0.56-1.61, p < 0.0001). Similarly, acupuncture plus herbs was significantly better than herbs alone on increase of sleep rates (RR 1.67, 95% CI 1.12-2.50, p = 0.01). There were no serious adverse effects with related to acupuncture treatment in the included trials.
CONCLUSIONS
Acupuncture appears to be effective in treatment of insomnia. However, further large, rigorous designed trials are warranted.
背景
在中国，针刺常用于治疗失眠，临床研究表明，与西药相比，针刺可能对失眠有一定疗效。
方法
我们纳入了针刺治疗失眠的随机对照试验。检索了PubMed、Cochrane 图书馆（2008 年第 3 期）、中国知网（CNKI）、中文科技期刊数据库（VIP）和万方数据库，检索均截止到 2008 年 12 月。由两位作者独立提取数据和评价试验质量。采用 RevMan 5.0.17 软件进行数据分析，效应指标采用相对危险度（RR）和均数差（MD）及其 95%可信区间（95%CI）表示。
结果
共纳入 46 项随机试验，涉及 3811 例患者。试验方法质量总体上在随机、盲法和意向治疗分析方面较好。Meta 分析显示，针刺治疗与空白对照相比（MD-3.28，95%CI-6.10 至-0.46，p=0.02；4 项试验）和真针刺与假针刺相比（MD-2.94，95%CI-5.77 至-0.11，p=0.04；2 项试验）在匹兹堡睡眠质量指数总分上有更好的疗效。针刺在增加总睡眠时间>3 小时的患者比例上优于西药（RR 1.53，95%CI 1.24-1.88，p<0.0001）。然而，针刺和西药在平均睡眠时间上无差异（MD-0.06，95%CI-0.30 至-0.18，p=0.63）。针刺加西药在总睡眠时间上的疗效优于西药（MD 1.09，95%CI 0.56-1.61，p<0.0001）。同样，针刺加草药在增加睡眠率上也显著优于单独使用草药（RR 1.67，95%CI 1.12-2.50，p=0.01）。纳入的试验中，针刺相关治疗无严重不良事件。
结论
针刺治疗失眠有效，但需要进一步进行更大规模、严格设计的试验。
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