Wu Qiqi, Hu Hantong, Han Dexiong, Gao Hong
The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, China.
Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Front Neurol. 2021 Aug 26;12:676525. doi: 10.3389/fneur.2021.676525. eCollection 2021.
Postherpetic neuralgia (PHN) is one of the most common complications of herpes zoster (HZ), and there is still a lack of effective therapies. An increasing number of studies have found that compared to traditional therapy, moxibustion treatment is beneficial for the treatment of PHN, although current evidence remains inconclusive. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of moxibustion for PHN. We conducted a broad literature review of a range of databases from inception to December 2020, including the Cochrane Library, PubMed, EMBASE, Web of Science, Clinical Trails, China National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals (VIP), China Biomedical Network Information, and Wanfang databases. We included RCTs that compared moxibustion to pharmacological therapies, herbal medicine, or no treatment for treating PHN. The main outcome measure was efficacy rate and Visual Analog Scale (VAS); the secondary outcome measure was adverse events. Data accumulation and synthesis included meta-analysis, publication bias, sensitivity analysis, risk-of-bias assessment, and adverse events. We included 13 RCTs involving 798 patients. Compared with the controls (pharmacological therapies, herbal medicine, or no treatment), moxibustion achieved a significantly higher efficacy rate (odds ratio [OR]: 3.65; 95% [confidence interval]: [2.32, 5.72]; < 0.00001). Subgroup analysis of the distinct moxibustion modalities showed that both Zhuang medicine medicated thread and thunder-fire moxibustions obtained higher clinical efficacy than the control group. Compared with the controls, moxibustion resulted in significantly lower scores on the VAS (Weighted Mean Difference (MD) = -1.79; 95% CI: [-2.26, -1.33]; < 0.00001). However, there was no significant difference in terms of safety between moxibustion and the controls (OR = 0.33; 95% CI [0.06, 1.77]; = 0.19). Due to the lack of methodological quality as well as the significant heterogeneity of the included studies, it remains difficult to draw a firm conclusion on the efficacy and safety of moxibustion for the treatment of PHN. Future high-quality studies are urgently needed.
带状疱疹后神经痛（PHN）是带状疱疹（HZ）最常见的并发症之一，目前仍缺乏有效的治疗方法。越来越多的研究发现，与传统疗法相比，艾灸治疗对PHN的治疗有益，尽管目前的证据仍不确凿。这项对随机对照试验（RCT）的系统评价和荟萃分析旨在评估艾灸治疗PHN的疗效和安全性。我们对从建库至2020年12月的一系列数据库进行了广泛的文献综述，包括Cochrane图书馆、PubMed、EMBASE、科学网、临床研究、中国知网（CNKI）、中文科技期刊数据库（VIP）、中国生物医学网络信息库和万方数据库。我们纳入了比较艾灸与药物疗法、草药或不治疗PHN的RCT。主要结局指标是有效率和视觉模拟量表（VAS）；次要结局指标是不良事件。数据积累和综合包括荟萃分析、发表偏倚、敏感性分析、偏倚风险评估和不良事件。我们纳入了13项涉及798例患者的RCT。与对照组（药物疗法、草药或不治疗）相比，艾灸的有效率显著更高（优势比[OR]：3.65；95%[置信区间]：[2.32, 5.72]；<0.00001）。对不同艾灸方式的亚组分析表明，壮医药线灸和雷火灸的临床疗效均高于对照组。与对照组相比，艾灸后的VAS评分显著更低（加权均数差[MD]= -1.79；95%CI：[-2.26, -1.33]；<0.00001）。然而，艾灸与对照组在安全性方面无显著差异（OR = 0.33；95%CI [0.06, 1.77]；P = 0.19）。由于纳入研究的方法学质量欠佳以及显著的异质性，目前仍难以就艾灸治疗PHN的疗效和安全性得出确凿结论。迫切需要未来开展高质量的研究。
