Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China.
The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.
Front Public Health. 2022 Nov 24;10:1022145. doi: 10.3389/fpubh.2022.1022145. eCollection 2022.
BACKGROUND: Acupuncture and moxibustion have been widely used in the treatment of Irritable Bowel Syndrome (IBS). But the evidence that acupuncture and moxibustion for IBS reduction of symptom severity and abdominal pain, and improvement of quality of life is scarce. METHODS: PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wanfang Database, China Biomedical Literature Service System (SinoMed), and unpublished sources were searched from inception until June 30, 2022. The quality of RCTs was assessed with the Cochrane Collaboration risk of bias tool. The strength of the evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation system (GRADE). Trial sequential analysis (TSA) was conducted to determine whether the participants in the included trials had reached optimal information size and whether the cumulative data was adequately powered to evaluate outcomes. RESULTS: A total of 31 RCTs were included. Acupuncture helped reduce the severity of symptoms more than pharmaceutical drugs (MD, -35.45; 95% CI, -48.21 to -22.68; = 71%). TSA showed the cumulative Z score crossed O'Brien-Fleming alpha-spending significance boundaries. Acupuncture wasn't associated with symptom severity reduction (SMD, 0.03, 95% CI, -0.25 to 0.31, = 46%), but exhibited therapeutic benefits on abdominal pain (SMD, -0.24; 95% CI, -0.48 to -0.01; = 8%) compared to sham acupuncture. Moxibustion show therapeutic benefits compared to sham moxibustion on symptom severity (SMD, -3.46, 95% CI, -5.66 to -1.27, = 95%) and abdominal pain (SMD, -2.74, 95% CI, -4.81 to -0.67, = 96%). Acupuncture (SMD, -0.46; 95% CI, -0.68 to -0.24; = 47%) and the combination of acupuncture and moxibustion (SMD, -2.00; 95% CI, -3.04 to -0.96; = 90%) showed more benefit for abdominal pain compared to pharmacological medications as well as shams. Acupuncture (MD, 4.56; 95% CI, 1.46-7.67; = 79%) and moxibustion (MD, 6.97; 95% CI, 5.78-8.16; = 21%) were more likely to improve quality of life than pharmaceutical drugs. CONCLUSION: Acupuncture and/or moxibustion are beneficial for symptom severity, abdominal pain and quality of life in IBS. However, in sham control trials, acupuncture hasn't exhibited robust and stable evidence, and moxibustion's results show great heterogeneity. Hence, more rigorous sham control trials of acupuncture or moxibustion are necessary. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=262118, identifier CRD42021262118.
背景：针灸已广泛应用于肠易激综合征（IBS）的治疗。但针灸减轻 IBS 症状严重程度和腹痛，改善生活质量的证据仍然不足。
方法：从建库至 2022 年 6 月 30 日，我们检索了 PubMed、Embase、Cochrane 图书馆、Web of Science、中国知网（CNKI）、中文科技期刊数据库（VIP）、万方数据库、中国生物医学文献服务系统（SinoMed）和未发表的资源。我们使用 Cochrane 协作偏倚风险工具评估 RCT 的质量。使用 Grading of Recommendations Assessment, Development and Evaluation 系统（GRADE）评估证据的强度。我们进行了试验序贯分析（TSA），以确定纳入试验的参与者是否达到了最佳信息大小，以及累积数据是否有足够的效力来评估结局。
结果：共纳入 31 项 RCT。与药物治疗相比，针灸更有助于减轻症状严重程度（MD，-35.45；95%CI，-48.21 至-22.68； = 71%）。TSA 显示累积 Z 得分穿过了 O'Brien-Fleming α 耗散显著性边界。针灸与症状严重程度的减轻无关（SMD，0.03，95%CI，-0.25 至 0.31， = 46%），但与假针灸相比，对腹痛具有治疗作用（SMD，-0.24；95%CI，-0.48 至-0.01； = 8%）。与假艾灸相比，艾灸在症状严重程度（SMD，-3.46，95%CI，-5.66 至-1.27， = 95%）和腹痛（SMD，-2.74，95%CI，-4.81 至-0.67， = 96%）方面具有治疗益处。与药物治疗相比，针灸（SMD，-0.46；95%CI，-0.68 至-0.24； = 47%）和针灸联合艾灸（SMD，-2.00；95%CI，-3.04 至-0.96； = 90%）对腹痛的改善更有益。与药物治疗相比，针灸（MD，4.56；95%CI，1.46-7.67； = 79%）和艾灸（MD，6.97；95%CI，5.78-8.16； = 21%）更有可能改善生活质量。
结论：针灸和/或艾灸对 IBS 的症状严重程度、腹痛和生活质量有益。然而，在假对照试验中，针灸尚未表现出稳健且稳定的证据，艾灸的结果显示出很大的异质性。因此，有必要进行更严格的针灸假对照试验。
系统综述注册：https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=262118，标识符 CRD42021262118。
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