Qin Zongshi, Wu Jiani, Xu Chang, Liu Zhishun
Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China.
School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Ann Transl Med. 2019 Mar;7(6):116. doi: 10.21037/atm.2018.11.45.
The benefits of acupuncture on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) have been well established according to previous studies. However, uncertainty exists regarding the dose-response relationship between acupuncture sessions and acupuncture effects for CP/CPPS. The objective of this study is to explore the association between the acupuncture sessions and its effects based on previously published data.
A non-linear meta-regression approach with restricted cubic spline (RCS) was used to investigate the dose-response relationship between acupuncture sessions and its effects on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). PubMed, EMBASE, and Cochrane CENTRAL were searched up to May 20, 2018. Randomized controlled trials (RCTs) and case series studies (CSSs) reported the treatment sessions of acupuncture for CP/CPPS with at least two categories were eligible for inclusion.
Ten studies involving 329 participants were included, the results showed a J-shaped dose-response association between acupuncture sessions and NIH-CPSI score (range 0 to 43, with higher score indicating greater CP/CPPS symptoms). Overall, more acupuncture sessions received for CP/CPPS patients is associated with increased symptom relieving. After 6 acupuncture sessions, the NIH-CPSI decreased from 26.1 (95% CI: 25.3-27.0) to 18.5 (95% CI: 11.6-25.4), with a between-session difference of -7.6 (95% CI: -14.6 to -0.7). Considering the 95%CI, both robust-error meta-regression modeling [MD: -8.3 (95% CI: -10.4 to -6.3)] and sensitivity analysis without CSSs [MD: -8.1 (95% CI: -9.5 to -6.7)] demonstrated that 18 acupuncture sessions could reach a clinically meaningful improvement regarding NIH-CPSI score.
There appear to be dose-response relationship between acupuncture sessions and CP/CPPS outcome. Prolonged acupuncture sessions were associated with less NIH-CPSI score. According to current evidence, six acupuncture sessions might be the minimal required 'dose' to reach its clinical effects.
根据先前的研究，针灸对慢性前列腺炎/慢性盆腔疼痛综合征（CP/CPPS）的益处已得到充分证实。然而，关于针灸疗程与CP/CPPS针灸效果之间的剂量反应关系仍存在不确定性。本研究的目的是基于先前发表的数据探讨针灸疗程与其效果之间的关联。
采用带有受限立方样条（RCS）的非线性Meta回归方法，研究针灸疗程与其对美国国立卫生研究院慢性前列腺炎症状指数（NIH-CPSI）影响之间的剂量反应关系。检索截至2018年5月20日的PubMed、EMBASE和Cochrane CENTRAL。报告了至少两类CP/CPPS针灸治疗疗程的随机对照试验（RCT）和病例系列研究（CSS）符合纳入标准。
纳入了10项涉及329名参与者的研究，结果显示针灸疗程与NIH-CPSI评分之间呈J形剂量反应关系（范围为0至43，评分越高表明CP/CPPS症状越严重）。总体而言，CP/CPPS患者接受的针灸疗程越多，症状缓解越明显。6次针灸疗程后，NIH-CPSI从26.1（95%CI：25.3-27.0）降至18.5（95%CI：11.6-25.4），每次疗程之间的差异为-7.6（95%CI：-14.6至-0.7）。考虑到95%CI，稳健误差Meta回归模型[MD：-8.3（95%CI：-10.4至-6.3）]和不包括CSS的敏感性分析[MD：-8.1（95%CI：-9.5至-6.7）]均表明，18次针灸疗程在NIH-CPSI评分方面可实现具有临床意义的改善。
针灸疗程与CP/CPPS结局之间似乎存在剂量反应关系。较长的针灸疗程与较低的NIH-CPSI评分相关。根据目前的证据，6次针灸疗程可能是达到其临床效果所需的最小“剂量”。
