Dodin Sylvie, Blanchet Claudine, Marc Isabelle, Ernst Edzard, Wu Taixiang, Vaillancourt Caroline, Paquette Joalee, Maunsell Elizabeth
Department of Obstetrics and Gynecology, Université Laval, Quebec, Canada.
Cochrane Database Syst Rev. 2013 Jul 30;2013(7):CD007410. doi: 10.1002/14651858.CD007410.pub2.
Hot flushes are the most common menopausal vasomotor symptom. Hormone therapy (HT) has frequently been recommended for relief of hot flushes, but concerns about the health risks of HT have encouraged women to seek alternative treatments. It has been suggested that acupuncture may reduce hot flush frequency and severity.
To determine whether acupuncture is effective and safe for reducing hot flushes and improving the quality of life of menopausal women with vasomotor symptoms.
We searched the following databases in January 2013: the Cochrane Menstrual Disorders and Subfertility Group Specialised Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CINAHL, PsycINFO, Chinese Biomedical Literature Database (CBM), Chinese Medical Current Content (CMCC), China National Knowledge Infrastructure (CNKI), VIP database, Dissertation Abstracts International, Current Controlled Trials, Clinicaltrials.gov, National Center for Complementary and Alternative Medicine (NCCAM), BIOSIS, AMED, Acubriefs, and Acubase.
Randomized controlled trials comparing any type of acupuncture to no treatment/control or other treatments for reducing menopausal hot flushes and improving the quality of life of symptomatic perimenopausal/postmenopausal women were eligible for inclusion.
Sixteen studies, with 1155 women, were eligible for inclusion. Three review authors independently assessed trial eligibility and quality, and extracted data. We pooled data where appropriate and calculated mean differences (MDs) and standardized mean differences (SMDs) with 95% confidence intervals (CI). We evaluated the overall quality of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
Eight studies compared acupuncture versus sham acupuncture. No significant difference was found between the groups for hot flush frequency (MD -1.13 flushes per day, 95% CI -2.55 to 0.29, 8 RCTs, 414 women, I(2) = 70%, low-quality evidence) but flushes were significantly less severe in the acupuncture group, with a small effect size (SMD -0.45, 95% CI -0.84 to -0.05, 6 RCTs, 297 women, I(2) = 62%, very-low-quality evidence). There was substantial heterogeneity for both these outcomes. In a post hoc sensitivity analysis excluding studies of women with breast cancer, heterogeneity was reduced to 0% for hot flush frequency and 34% for hot flush severity and there was no significant difference between the groups for either outcome.Three studies compared acupuncture versus HT. Acupuncture was associated with significantly more frequent hot flushes than HT (MD 3.18 flushes per day, 95% CI 2.06 to 4.29, 3 RCTs, 114 women, I(2) = 0%, low-quality evidence). There was no significant difference between the groups for hot flush severity (SMD 0.53, 95% CI -0.14 to 1.20, 2 RCTs, 84 women, I(2) = 57%, low-quality evidence).One study compared electroacupuncture versus relaxation. There was no significant difference between the groups for either hot flush frequency (MD -0.40 flushes per day, 95% CI -2.18 to 1.38, 1 RCT, 38 women, very-low-quality evidence) or hot flush severity (MD 0.20, 95% CI -0.85 to 1.25, 1 RCT, 38 women, very-low-quality evidence).Four studies compared acupuncture versus waiting list or no intervention. Traditional acupuncture was significantly more effective in reducing hot flush frequency from baseline (SMD -0.50, 95% CI -0.69 to -0.31, 3 RCTs, 463 women, I(2) = 0%, low-quality evidence), and was also significantly more effective in reducing hot flush severity (SMD -0.54, 95% CI -0.73 to -0.35, 3 RCTs, 463 women, I(2) = 0%, low-quality evidence). The effect size was moderate in both cases.For quality of life measures, acupuncture was significantly less effective than HT, but traditional acupuncture was significantly more effective than no intervention. There was no significant difference between acupuncture and other comparators for quality of life. Data on adverse effects were lacking.
AUTHORS' CONCLUSIONS: We found insufficient evidence to determine whether acupuncture is effective for controlling menopausal vasomotor symptoms. When we compared acupuncture with sham acupuncture, there was no evidence of a significant difference in their effect on menopausal vasomotor symptoms. When we compared acupuncture with no treatment there appeared to be a benefit from acupuncture, but acupuncture appeared to be less effective than HT. These findings should be treated with great caution as the evidence was low or very low quality and the studies comparing acupuncture versus no treatment or HT were not controlled with sham acupuncture or placebo HT. Data on adverse effects were lacking.
潮热是最常见的绝经血管舒缩症状。激素疗法（HT）常被推荐用于缓解潮热，但对HT健康风险的担忧促使女性寻求替代疗法。有人认为针灸可能会降低潮热的频率和严重程度。
确定针灸对于减轻有血管舒缩症状的绝经女性的潮热及改善其生活质量是否有效且安全。
我们于2013年1月检索了以下数据库：Cochrane月经紊乱与生育力低下小组专业试验注册库、Cochrane对照试验中央注册库（CENTRAL）、PubMed、EMBASE、CINAHL、PsycINFO、中国生物医学文献数据库（CBM）、中国医学现刊（CMCC）、中国知网（CNKI）、维普数据库、国际学位论文摘要数据库、当前对照试验、Clinicaltrials.gov、国立补充与替代医学中心（NCCAM）、BIOSIS、AMED、针灸摘要数据库和针灸数据库。
比较任何类型的针灸与不治疗/对照或其他治疗方法以减轻绝经潮热并改善有症状的围绝经期/绝经后女性生活质量的随机对照试验均符合纳入标准。
16项研究符合纳入标准，涉及1155名女性。三位综述作者独立评估试验的纳入资格和质量，并提取数据。我们在适当情况下合并数据，并计算了95%置信区间（CI）的平均差（MDs）和标准化平均差（SMDs）。我们使用推荐分级的评估、制定与评价（GRADE）标准评估证据的总体质量。
八项研究比较了针灸与假针灸。两组在潮热频率上无显著差异（MD -1.13次/天，95%CI -2.55至0.29，8项随机对照试验，414名女性，I² = 70%，低质量证据），但针灸组的潮热严重程度显著较轻，效应量较小（SMD -0.45，95%CI -0.84至-0.05，6项随机对照试验，297名女性，I² = 62%，极低质量证据）。这两个结果均存在较大异质性。在一项排除乳腺癌女性研究的事后敏感性分析中，潮热频率的异质性降至0%，潮热严重程度的异质性降至34%，两组在这两个结果上均无显著差异。三项研究比较了针灸与HT。针灸组的潮热频率显著高于HT组（MD 3.18次/天，95%CI 2.06至4.29，3项随机对照试验，114名女性，I² = 0%，低质量证据）。两组在潮热严重程度上无显著差异（SMD 0.53，95%CI -0.14至1.20，2项随机对照试验，84名女性，I² = 57%，低质量证据）。一项研究比较了电针与放松疗法。两组在潮热频率（MD -0.40次/天，95%CI -2.18至1.38，1项随机对照试验，38名女性，极低质量证据）或潮热严重程度（MD 0.20，95%CI -0.85至1.25，1项随机对照试验，38名女性，极低质量证据）上均无显著差异。四项研究比较了针灸与等待列表或无干预。传统针灸在降低潮热频率方面比基线时显著更有效（SMD -0.50，95%CI -0.69至-0.31，3项随机对照试验，463名女性，I² = 0%，低质量证据），在降低潮热严重程度方面也显著更有效（SMD -0.54，95%CI -0.73至-0.35，3项随机对照试验，463名女性，I² = 0%，低质量证据）。两种情况下的效应量均为中等。对于生活质量指标，针灸的效果显著低于HT，但传统针灸显著优于无干预。针灸与其他对照在生活质量方面无显著差异。缺乏不良反应数据。
我们发现证据不足，无法确定针灸对于控制绝经血管舒缩症状是否有效。当我们将针灸与假针灸进行比较时，没有证据表明它们对绝经血管舒缩症状的影响存在显著差异。当我们将针灸与不治疗进行比较时，针灸似乎有一定益处，但针灸似乎比HT效果差。这些发现应谨慎对待，因为证据质量低或极低，且比较针灸与不治疗或HT的研究未采用假针灸或安慰剂HT进行对照。缺乏不良反应数据。
