Shi Yun-Zhou, Tao Qing-Feng, Qin Di, Chen Min, Yu Shu-Guang, Zheng Hui
Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Front Physiol. 2022 Oct 6;13:1001978. doi: 10.3389/fphys.2022.1001978. eCollection 2022.
Acupuncture has been extensively applied to manage irritable bowel syndrome (IBS) in clinical practice in China. Some randomized controlled trials (RCTs) have demonstrated their efficacy, but it has rarely been compared with first-line antispasmodics to verify their effectiveness. Therefore, we compare acupuncture with antispasmodics in the treatment of IBS by using an adjusted indirect treatment comparison meta-analysis. Embase, OVID Medline, and the Cochrane Central Register of Controlled Trials databases were searched from inception to 14 March 2022, with no language restrictions. RCTs comparing antispasmodics or acupuncture with placebo or one of the antispasmodics were enrolled. The primary outcome of interest was the improvement of abdominal pain. And the secondary outcomes of interest were the relief of global IBS symptoms and adverse events. The random-effects model was utilized to pool data. The effect size was measured by standardized mean difference (SMD) or relative ratio, and the effectiveness of acupuncture and different antispasmodics were ranked by P-scores. Thirty-five RCTs (n = 5,190) were included. The analysis showed that cimetropium, drotaverine, acupuncture, and pinarverium were superior over placebo in relieving abdominal pain; cimetropium (SMD, -3.00 [95%CI, -4.47 to -1.53], P-score = 0.99) ranked the most effective. In pairwise comparisons, acupuncture had a greater improvement than most antispasmodics except cimetropium and drotaverine in relieving abdominal pain, although the between-group difference was statistically insignificant. In the analysis of continuous outcome in the relief of global IBS symptoms, the result showed that pinaverium was more effective (SMD, 1.72 [95%CI, 0.53 to 2.92], P-score = 0.90) than placebo. Trimebutine and acupuncture had greater improvements than placebo, but no significant difference was shown between groups. In pairwise comparisons, acupuncture was more effective than pinaverium (SMD, -1.11 [95%CI, -1.94 to -0.28]) in relieving global IBS symptoms. In the analysis of adverse events, acupuncture had a lower adverse event rate than most of the other antispasmodics. Cimetropium, drotaverine, and acupuncture were all better than placebo in improving abdominal pain. Acupuncture was preferred over pinaverium in relieving global IBS symptoms, and acupuncture had lower adverse events than most antispasmodics.
在中国的临床实践中，针灸已被广泛应用于管理肠易激综合征（IBS）。一些随机对照试验（RCT）已证明其疗效，但很少与一线解痉药进行比较以验证其有效性。因此，我们通过使用调整后的间接治疗比较荟萃分析，比较针灸与解痉药在IBS治疗中的效果。检索了Embase、OVID Medline和Cochrane对照试验中央注册库数据库，时间跨度从创建到2022年3月14日，无语言限制。纳入了比较解痉药或针灸与安慰剂或一种解痉药的RCT。感兴趣的主要结局是腹痛的改善。感兴趣的次要结局是IBS整体症状的缓解和不良事件。采用随机效应模型汇总数据。效应量通过标准化均数差（SMD）或相对比来衡量，针灸和不同解痉药的有效性通过P值进行排序。共纳入35项RCT（n = 5190）。分析表明，西托溴铵、屈他维林、针灸和匹维溴铵在缓解腹痛方面优于安慰剂；西托溴铵（SMD，-3.00 [95%CI，-4.47至-1.53]，P值 = 0.99）排名最有效。在两两比较中，针灸在缓解腹痛方面比除西托溴铵和屈他维林之外的大多数解痉药有更大改善，尽管组间差异无统计学意义。在IBS整体症状缓解的连续结局分析中，结果显示匹维溴铵比安慰剂更有效（SMD，1.72 [95%CI，0.53至2.92]，P值 = 0.90）。曲美布汀和针灸比安慰剂有更大改善，但组间无显著差异。在两两比较中，针灸在缓解IBS整体症状方面比匹维溴铵更有效（SMD，-1.11 [95%CI，-1.94至-0.28]）。在不良事件分析中，针灸的不良事件发生率低于大多数其他解痉药。西托溴铵、屈他维林和针灸在改善腹痛方面均优于安慰剂。针灸在缓解IBS整体症状方面优于匹维溴铵，且针灸的不良事件比大多数解痉药少。
