Xu Yang, Zhao Wenli, Li Te, Zhao Ye, Bu Huaien, Song Shilin
Department of Gynecology and Obstetrics, Nankai Hospital, Tianjin Academy of Integrative Medicine, Tianjin, China.
Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
PLoS One. 2017 Oct 27;12(10):e0186616. doi: 10.1371/journal.pone.0186616. eCollection 2017.
Endometriosis is a multifactorial, oestrogen-dependent, inflammatory, gynaecological condition that can result in long-lasting visceral pelvic pain and infertility. Acupuncture could be an effective treatment for endometriosis and may relieve pain. Our aim in the present study was to determine the effectiveness of acupuncture as a treatment for endometriosis-related pain.
In December 2016, six databases were searched for randomised controlled trials that determined the effectiveness of acupuncture in the treatment of endometriosis-related pain. Ultimately, 10 studies involving 589 patients were included. The main outcomes assessed were variation in pain level, variation in peripheral blood CA-125 level, and clinical effective rate. All analyses were performed using comprehensive meta-analysis statistical software.
Of the 10 studies included, only one pilot study used a placebo control and assessed blinding; the rest used various controls (medications and herbs), which were impossible to blind. The sample sizes were small in all studies, ranging from 8 to 36 patients per arm. The mean difference (MD) in pain reduction (pre- minus post-interventional pain level-measured on a 0-10-point scale) between the acupuncture and control groups was 1.36 (95% confidence intervals [CI] = 1.01-1.72, P<0.0001). Acupuncture had a positive effect on peripheral blood CA-125 levels, as compared with the control groups (MD = 5.9, 95% CI = 1.56-10.25, P = 0.008). Similarly, the effect of acupuncture on clinical effective rate was positive, as compared with the control groups (odds ratio = 2.07; 95% CI = 1.24-3.44, P = 0.005).
Few randomised, blinded clinical trials have addressed the efficacy of acupuncture in treating endometriosis-related pain. Nonetheless, the current literature suggests that acupuncture reduces pain and serum CA-125 levels, regardless of the control intervention used. To confirm these findings, additional, blinded studies with proper controls and adequate sample sizes are needed.
子宫内膜异位症是一种多因素、雌激素依赖性、炎症性妇科疾病，可导致长期的盆腔内脏疼痛和不孕。针灸可能是治疗子宫内膜异位症的有效方法，且可能缓解疼痛。我们在本研究中的目的是确定针灸治疗子宫内膜异位症相关疼痛的有效性。
2016年12月，检索了六个数据库，以查找确定针灸治疗子宫内膜异位症相关疼痛有效性的随机对照试验。最终，纳入了10项涉及589例患者的研究。评估的主要结局为疼痛水平的变化、外周血CA-125水平的变化以及临床有效率。所有分析均使用综合荟萃分析统计软件进行。
在纳入的10项研究中，只有一项试点研究使用了安慰剂对照并评估了盲法；其余研究使用了各种对照（药物和草药），无法进行盲法。所有研究的样本量都很小，每组患者人数从8至36例不等。针灸组与对照组之间疼痛减轻的平均差值（MD）（干预前减去干预后疼痛水平，采用0至10分制测量）为1.36（95%置信区间[CI]=1.01-1.72，P<0.0001）。与对照组相比，针灸对外周血CA-125水平有积极影响（MD=5.9，95%CI=1.56-10.25，P=0.008）。同样，与对照组相比，针灸对临床有效率的影响是积极的（比值比=2.07；95%CI=1.24-3.44，P=0.005）。
很少有随机、盲法临床试验探讨针灸治疗子宫内膜异位症相关疼痛的疗效。尽管如此，目前的文献表明，无论使用何种对照干预，针灸均可减轻疼痛并降低血清CA-125水平。为证实这些发现，需要进行更多有适当对照和足够样本量的盲法研究。
