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针刺治疗慢性前列腺炎/慢性骨盆疼痛综合征的疗效:一项随机试验。

Efficacy of Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome : A Randomized Trial.

机构信息

Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (Y.S., B.L., Z.Q., J.Z., J.W., X.L., W.W., R.P., H.C., X.W., Z.L.).

Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (Y.L.).

出版信息

Ann Intern Med. 2021 Oct;174(10):1357-1366. doi: 10.7326/M21-1814. Epub 2021 Aug 17.

Abstract

BACKGROUND

Acupuncture has promising effects on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), but high-quality evidence is scarce.

OBJECTIVE

To assess the long-term efficacy of acupuncture for CP/CPPS.

DESIGN

Multicenter, randomized, sham-controlled trial. (ClinicalTrials.gov: NCT03213938).

SETTING

Ten tertiary hospitals in China.

PARTICIPANTS

Men with moderate to severe CP/CPPS, regardless of prior exposure to acupuncture.

INTERVENTION

Twenty sessions of acupuncture or sham acupuncture over 8 weeks, with 24-week follow-up after treatment.

MEASUREMENTS

The primary outcome was the proportion of responders, defined as participants who achieved a clinically important reduction of at least 6 points from baseline on the National Institutes of Health Chronic Prostatitis Symptom Index at weeks 8 and 32. Ascertainment of sustained efficacy required the between-group difference to be statistically significant at both time points.

RESULTS

A total of 440 men (220 in each group) were recruited. At week 8, the proportions of responders were 60.6% (95% CI, 53.7% to 67.1%) in the acupuncture group and 36.8% (CI, 30.4% to 43.7%) in the sham acupuncture group (adjusted difference, 21.6 percentage points [CI, 12.8 to 30.4 percentage points]; adjusted odds ratio, 2.6 [CI, 1.8 to 4.0];  < 0.001). At week 32, the proportions were 61.5% (CI, 54.5% to 68.1%) in the acupuncture group and 38.3% (CI, 31.7% to 45.4%) in the sham acupuncture group (adjusted difference, 21.1 percentage points [CI, 12.2 to 30.1 percentage points]; adjusted odds ratio, 2.6 [CI, 1.7 to 3.9];  < 0.001). Twenty (9.1%) and 14 (6.4%) adverse events were reported in the acupuncture and sham acupuncture groups, respectively. No serious adverse events were reported.

LIMITATION

Sham acupuncture might have had certain physiologic effects.

CONCLUSION

Compared with sham therapy, 20 sessions of acupuncture over 8 weeks resulted in greater improvement in symptoms of moderate to severe CP/CPPS, with durable effects 24 weeks after treatment.

PRIMARY FUNDING SOURCE

China Academy of Chinese Medical Sciences and the National Administration of Traditional Chinese Medicine.

摘要

背景

针灸对慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)有很好的疗效,但高质量的证据仍然不足。

目的

评估针灸治疗 CP/CPPS 的长期疗效。

设计

多中心、随机、假对照试验。(ClinicalTrials.gov:NCT03213938)。

地点

中国 10 家三级医院。

参与者

患有中重度 CP/CPPS 的男性,无论是否有过针灸治疗史。

干预

20 次针灸或假针灸治疗,持续 8 周,治疗后随访 24 周。

测量

主要结果是应答者的比例,定义为 NIH 慢性前列腺炎症状指数基线值下降至少 6 分的患者比例,在第 8 周和第 32 周。持续疗效的确定需要在两个时间点的组间差异具有统计学意义。

结果

共招募了 440 名男性(每组 220 名)。第 8 周时,针灸组的应答者比例为 60.6%(95%可信区间,53.7%至 67.1%),假针灸组为 36.8%(95%可信区间,30.4%至 43.7%)(调整后的差异,21.6 个百分点[95%可信区间,12.8 至 30.4 个百分点];调整后的比值比,2.6[95%可信区间,1.8 至 4.0];<0.001)。第 32 周时,针灸组的应答者比例为 61.5%(95%可信区间,54.5%至 68.1%),假针灸组为 38.3%(95%可信区间,31.7%至 45.4%)(调整后的差异,21.1 个百分点[95%可信区间,12.2 至 30.1 个百分点];调整后的比值比,2.6[95%可信区间,1.7 至 3.9];<0.001)。针灸组和假针灸组分别报告了 20 例(9.1%)和 14 例(6.4%)不良事件。未报告严重不良事件。

局限性

假针灸可能具有一定的生理效应。

结论

与假治疗相比,8 周内进行 20 次针灸治疗可显著改善中重度 CP/CPPS 的症状,治疗后 24 周仍有持久疗效。

主要资金来源

中国中医科学院和国家中医药管理局。

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