针刺疗法治疗膀胱过度活动症：一项系统评价与荟萃分析。
Acupuncture for the treatment of overactive bladder: A systematic review and meta-analysis.
作者信息
Lee Jung-Ju, Heo Jeong-Weon, Choi Tae-Young, Jun Ji Hee, Lee Myeong Soo, Kim Jong-In
机构信息
Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea.
KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea.
出版信息
Front Neurol. 2023 Jan 12;13:985288. doi: 10.3389/fneur.2022.985288. eCollection 2022.
BACKGROUND
Acupuncture (AT) successfully regulates overactive bladder (OAB) symptoms. However, previous systematic reviews and meta-analyses have not provided sufficient evidence. This review presents the current evidence of the efficacy of AT in the management of OAB symptoms.
METHODS AND ANALYSES
A total of 12 databases were searched from their inception: PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and AMED databases; five Korean medical databases; and three Chinese medical databases. Study selection, data extraction, and assessment were independently performed by two researchers. The risk of bias was assessed using the Cochrane risk of bias assessment tool. RevMan 5.4.1 software was used for data aggregation, and the Grades of Recommendations, Assessment, Development and Evaluation (GRADE) assessment was used to evaluate the quality of the study outcomes.
RESULTS
A total of 30 studies were included in this review. Compared with the sham AT group, the AT group exhibited significant effects in reducing overactive bladder symptom scores (OABSS) [mean difference (MD): -1.13, 95% confidence interval (CI): -2.01 to -0.26, = 0.01 = 67%] and urinary frequency [standardized mean difference (SMD): -0.35, 95% CI: -0.62 to -0.08, = 0%]. The AT group showed an equivalent effect as drug therapy in reducing OABSS (MD: -0.39, 95% CI: - 1.92 to 1.13, = 0.61, = 94%) and urinary frequency (MD: 0.74, 95% CI: -0.00 to 1.48, = 0.05, = 71%) with fewer adverse events [risk ratio (RR): 0.38, 95% CI: 0.16-0.92, = 0.03, I = 58%]. The AT plus drug therapy group had a more favorable effect than drug therapy alone for reducing OABSS (MD: -2.28, 95% CI: -3.25 to -1.31, < 0.00001, = 84%) and urinary frequency (MD: -2.34, 95% CI: -3.29 to -1.38, < 0.00001, = 88%). The GRADE assessment demonstrated that the level of evidence was mostly low or very low given the high risk of bias and small sample sizes.
CONCLUSION
AT had more favorable effects than sham AT in reducing OAB symptoms. AT improved OAB symptoms as effectively as conventional drug therapy, and the combination of AT and drug therapy had more favorable effects than drug therapy alone. However, more rigorous studies are needed to enhance the level of evidence.
SYSTEMATIC REVIEW REGISTRATION
http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42014010377, identifier: PROSPERO [CRD42014010377].
背景
针灸（AT）成功调节膀胱过度活动症（OAB）症状。然而，以往的系统评价和荟萃分析并未提供充分证据。本综述展示了AT治疗OAB症状疗效的当前证据。
方法与分析
从数据库建立起共检索12个数据库：PubMed、EMBASE、Cochrane对照试验中央注册库（CENTRAL）和AMED数据库；5个韩国医学数据库；以及3个中国医学数据库。两名研究人员独立进行研究选择、数据提取和评估。使用Cochrane偏倚风险评估工具评估偏倚风险。采用RevMan 5.4.1软件进行数据汇总，并使用推荐分级、评估、制定与评价（GRADE）评估来评价研究结果的质量。
结果
本综述共纳入30项研究。与假针灸组相比，针灸组在降低膀胱过度活动症症状评分（OABSS）[平均差（MD）：-1.13，95%置信区间（CI）：-2.01至-0.26，P = 0.01，I² = 67%]和尿频[标准化平均差（SMD）：-0.35，95%CI：-0.62至-0.08，P = 0%]方面显示出显著效果。针灸组在降低OABSS（MD：-0.39，95%CI：-1.92至1.13，P = 0.61，I² = 94%）和尿频（MD：0.74，95%CI：-0.00至1.48，P = 0.05，I² = 71%）方面与药物治疗效果相当，但不良事件更少[风险比（RR）：0.38，95%CI：0.16 - 0.92，P = 0.03，I² = 58%]。针灸联合药物治疗组在降低OABSS（MD：-2.28，95%CI：-3.25至-1.31，P < 0.00001，I² = 84%）和尿频（MD：-2.34，95%CI：-3.29至-1.38，P < 0.00001，I² = 88%）方面比单纯药物治疗效果更优。GRADE评估表明，鉴于偏倚风险高和样本量小，证据水平大多为低或极低。
结论
针灸在减轻OAB症状方面比假针灸效果更优。针灸改善OAB症状的效果与传统药物治疗相当，且针灸与药物治疗联合使用比单纯药物治疗效果更优。然而，需要更严格的研究来提高证据水平。
系统评价注册
http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42014010377，标识符：PROSPERO [CRD42014010377]
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