Shi Yun-Zhou, Cao Wei, Li Chun-Xiao, Xiao Xian-Jun, Huang Ying, Zhang Lei-Xiao, Zou Zi-Hao, Chen Si-Jue, Yang Qian, Wang Lu, Hao Ping-Sheng, Gao Zi-Ping, Li Ying
Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
The Dermatology Department of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Evid Based Complement Alternat Med. 2022 Oct 27;2022:2094589. doi: 10.1155/2022/2094589. eCollection 2022.
Chronic urticaria (CU) can severely impair the quality of life. Acupuncture and related therapies have been widely used in the treatment of CU in China. This study aimed to summarize and critically evaluate the methodological and reporting quality of relevant systematic reviews (SRs) and present objective and comprehensive evidence on the effectiveness and safety of acupuncture and related therapies for CU.
Eight electronic databases were searched from inception to October 2021 for SRs examining acupuncture and related therapies for CU, and gray literature was manually searched. Two authors independently identified SRs and extracted data. The methodological and reporting quality of these SRs were assessed by the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool and preferred reporting items for SRs and meta-analyses (PRISMA, 2020), respectively. In addition, the risk of bias in systematic reviews (ROBIS) was used to evaluate the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was applied to evaluate the quality of evidence for outcome measures.
In total, 23 SRs, including a total of 11 outcome indicators, were published before October 2021. The AMSTAR-2 results showed that the methodological quality of all SRs was critically low; items 2, 3, 7, 9, 10, and 16 were found to have particularly low quality. For PRISMA, the reporting quality of the included SRs was unsatisfactory, and major reporting flaws were observed in the search strategy, synthesis method, certainly assessment, reporting biases, registrations, and financial support of the included SRs. For ROBIS, 22 SRs (95.65%) had a high risk of bias. Among the 55 outcomes assessed using the GRADE framework, there were 3 (5.45%) outcomes with moderate-quality evidence, 6 (10.91%) outcomes with low-quality evidence, and 46 (83.64%) outcomes with very low-quality evidence. We found the moderate quality of evidence indicating that the total effective rate and curing rate of the acupuncture group were higher than those of the western medicine group, and the recurrence rate was lower than that of the western medicine group.
Acupuncture and related therapies for the treatment of CU are supported by low-quality evidence-based medicine. However, considering the poor quality of these SRs, we suggest that studies with more rigorous designs, larger sample sizes, and higher methodological and reporting quality are necessary to provide stronger evidence. . The protocol for this study has been registered (PROSPERO registration number: CRD42021259131).
慢性荨麻疹（CU）会严重影响生活质量。针灸及相关疗法在中国已广泛应用于CU的治疗。本研究旨在总结并严格评估相关系统评价（SRs）的方法学和报告质量，并提供关于针灸及相关疗法治疗CU有效性和安全性的客观、全面证据。
检索了8个电子数据库自建库至2021年10月期间有关针灸及相关疗法治疗CU的SRs，并手工检索了灰色文献。两名作者独立识别SRs并提取数据。这些SRs的方法学和报告质量分别通过《多种系统评价评估2》（AMSTAR 2）工具和系统评价与Meta分析的首选报告项目（PRISMA，2020）进行评估。此外，系统评价中的偏倚风险（ROBIS）用于评估偏倚风险。应用推荐分级评估、制定和评价（GRADE）框架来评估结局指标的证据质量。
截至2021年10月，共发表了23篇SRs，共包含11项结局指标。AMSTAR-2结果显示，所有SRs的方法学质量极低；发现第2、3、7、9、10和16项的质量特别低。对于PRISMA，纳入的SRs的报告质量不令人满意，在纳入的SRs的检索策略、合成方法、确定性评估、报告偏倚、注册和资金支持方面观察到主要报告缺陷。对于ROBIS，22篇SRs（95.65%）存在高偏倚风险。在使用GRADE框架评估的55项结局中，有3项（5.45%）结局为中等质量证据，6项（10.91%）结局为低质量证据，46项（83.64%）结局为极低质量证据。我们发现中等质量证据表明针灸组的总有效率和治愈率高于西药组，复发率低于西药组。
针灸及相关疗法治疗CU有低质量的循证医学支持。然而，考虑到这些SRs质量较差，我们建议需要开展设计更严谨、样本量更大、方法学和报告质量更高的研究以提供更有力的证据。本研究方案已注册（PROSPERO注册号：CRD42021259131）。
