General Practice Department of Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong Province, China.
General Practice Department of Zhongshan Hospital of Fudan University, Shanghai City, China.
PLoS One. 2018 Apr 25;13(4):e0196128. doi: 10.1371/journal.pone.0196128. eCollection 2018.
The objective of this study was to compare the efficacy and side effects of acupuncture, sham acupuncture and drugs in the treatment of chronic constipation. Randomized controlled trials (RCTs) assessing the effects of acupuncture and drugs for chronic constipation were comprehensively retrieved from electronic databases (such as PubMed, Cochrane Library, Embase, CNKI, Wanfang Database, VIP Database and CBM) up to December 2017. Additional references were obtained from review articles. With quality evaluations and data extraction, a network meta-analysis (NMA) was performed using a random-effects model under a frequentist framework. A total of 40 studies (n = 11032) were included: 39 were high-quality studies and 1 was a low-quality study. NMA showed that (1) acupuncture improved the symptoms of chronic constipation more effectively than drugs; (2) the ranking of treatments in terms of efficacy in diarrhoea-predominant irritable bowel syndrome was acupuncture, polyethylene glycol, lactulose, linaclotide, lubiprostone, bisacodyl, prucalopride, sham acupuncture, tegaserod, and placebo; (3) the ranking of side effects were as follows: lactulose, lubiprostone, bisacodyl, polyethylene glycol, prucalopride, linaclotide, placebo and tegaserod; and (4) the most commonly used acupuncture point for chronic constipation was ST25. Acupuncture is more effective than drugs in improving chronic constipation and has the least side effects. In the future, large-scale randomized controlled trials are needed to prove this. Sham acupuncture may have curative effects that are greater than the placebo effect. In the future, it is necessary to perform high-quality studies to support this finding. Polyethylene glycol also has acceptable curative effects with fewer side effects than other drugs.
本研究旨在比较针灸、假针灸和药物治疗慢性便秘的疗效和副作用。系统检索了电子数据库（如 PubMed、Cochrane 图书馆、Embase、CNKI、万方数据库、维普数据库和 CBM）中截至 2017 年 12 月评估针灸和药物治疗慢性便秘效果的随机对照试验（RCTs）。此外，还从综述文章中获取了参考文献。采用基于频率论的随机效应模型进行网络荟萃分析（NMA），对质量评价和数据提取进行了分析。共纳入 40 项研究（n=11032）：39 项为高质量研究，1 项为低质量研究。NMA 结果显示：（1）针灸治疗慢性便秘的症状改善优于药物；（2）在腹泻为主型肠易激综合征中，治疗效果的排序为针灸、聚乙二醇、乳果糖、利那洛肽、鲁比前列酮、比沙可啶、普芦卡必利、假针灸、替加色罗和安慰剂；（3）副作用的排序为乳果糖、鲁比前列酮、比沙可啶、聚乙二醇、普芦卡必利、利那洛肽、安慰剂和替加色罗；（4）治疗慢性便秘最常用的穴位是 ST25。针灸在改善慢性便秘方面比药物更有效，且副作用最小。未来需要开展大规模 RCT 以证实这一点。假针灸可能具有优于安慰剂的疗效，未来需要开展高质量研究来支持这一发现。聚乙二醇也具有可接受的疗效，且副作用少于其他药物。
