Zhu Lingping, Ma Yunhui, Ye Shasha, Shu Zhiqun
General Practice Department of Shenzhen Longhua District Central Hospital, China.
Zhongshan Hospital of Fudan University, China.
Evid Based Complement Alternat Med. 2018 May 27;2018:2890465. doi: 10.1155/2018/2890465. 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 diarrhoea-predominant irritable bowel syndrome.
Randomized controlled trials (RCTs) assessing the effects of acupuncture and drugs 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 document quality evaluations and data extraction, Network Meta-Analysis was performed using a random-effects model under a frequentist framework.
A total of 29 studies (n = 9369) were included; 19 were high-quality studies, and 10 were low-quality studies. NMA showed the following: (1) the ranking of treatments in terms of efficacy in diarrhoea-predominant irritable bowel syndrome is acupuncture, sham acupuncture, pinaverium bromide, alosetron = eluxadoline, ramosetron, and rifaximin; (2) the ranking of treatments in terms of severity of side effects in diarrhoea-predominant irritable bowel syndrome is rifaximin, alosetron, ramosetron = pinaverium bromide, sham acupuncture, and acupuncture; and (3) the treatment of diarrhoea-predominant irritable bowel syndrome includes common acupoints such as ST25, ST36, ST37, SP6, GV20, and EX-HN3.
Acupuncture may improve diarrhoea-predominant irritable bowel syndrome better than drugs and has the fewest side effects. Sham acupuncture may have curative effect except for placebo effect. In the future, it is necessary to perform highly qualified research to prove this result. Pinaverium bromide also has good curative effects with fewer side effects than other drugs.
本研究旨在比较针刺、假针刺及药物治疗腹泻型肠易激综合征的疗效及副作用。
全面检索截至2017年12月电子数据库（如PubMed、Cochrane图书馆、Embase、中国知网、万方数据库、维普数据库和中国生物医学文献数据库）中评估针刺和药物疗效的随机对照试验（RCT）。从综述文章中获取其他参考文献。经文献质量评估和数据提取后，在频率学派框架下采用随机效应模型进行网状Meta分析。
共纳入29项研究（n = 9369）；19项为高质量研究，10项为低质量研究。网状Meta分析显示：（1）在腹泻型肠易激综合征的疗效方面，治疗方法的排序为针刺、假针刺、匹维溴铵、阿洛司琼 = 依鲁卡多林、雷莫司琼和利福昔明；（2）在腹泻型肠易激综合征的副作用严重程度方面，治疗方法的排序为利福昔明、阿洛司琼、雷莫司琼 = 匹维溴铵、假针刺和针刺；（3）腹泻型肠易激综合征的治疗包括常用穴位，如ST25、ST36、ST37、SP6、GV20和EX-HN3。
针刺治疗腹泻型肠易激综合征可能比药物效果更好且副作用最少。假针刺除安慰剂效应外可能有治疗作用。未来有必要开展高质量研究以证实该结果。匹维溴铵也有良好疗效，且副作用比其他药物少。
