Park Joon-Gon, Lee Bong Hyo, Na Ji-Ho, Jung Ji-Hyeo, Song Chang-Hyun
College of Korean Medicine, Daegu Haany University, Gyeongsan, 38610, Republic of Korea.
Department of Acupuncture, Moxibustion and Acupoint, College of Korean Medicine, Daegu Haany University, Daegu, 42158, Republic of Korea.
Heliyon. 2023 Jul 13;9(7):e18226. doi: 10.1016/j.heliyon.2023.e18226. eCollection 2023 Jul.
Previous meta-analyses have shown a superiority of acupuncture over artificial tear for treating typical dry eye syndrome (DES). However, given that the acupuncture protocols were quite diverse in the randomized controlled trials (RCTs) included in the meta-analyses, it is necessary to establish the acupuncture guidelines. Thus, the optimal acupuncture protocol involved in improvements of tear-film breakup time (BUT) or Schirmer tear test (STT) was examined by meta-analyses for RCTs in patients with typical DES. Eight databases until Jun 2018 were searched for 21 RCTs (n = 1542 eyes) comparing effectiveness of acupuncture versus artificial tear control. Indirect comparison of Bucher analysis was used to find specific acupoints (SAPs) improving BUT or STT by comparing the outcomes between subgroups of the RCTs including and excluding certain SAPs. Meta-analysis was examined for the outcomes in subgroups of the RCTs based on the number of SAPs, and network meta-analysis was for multiple pairwise comparisons across the protocols using the SAPs to yield relative effects. The Bucher analyses identified nine SAPs with positive effects on BUT or STT, and the positive relations of two SAPs involved in improvements of both BUT and STT suggested potential combinations of three ('KI3-LI4-SP6' or 'KI3-GB14-ST2') or four SAPs ('KI3-BL1-EX-HN7-SP6'). Subgroup meta-analyses showed the SAP-depending improvements of BUT or STT in the subgroups including more than three SAPs, compared with the artificial tear control. Meta-regression and network meta-analyses revealed significant correlations between the number of SAPs and the improvements of BUT and STT, and demonstrated that acupuncture using four SAPs for 21-30 days, particularly at two-three times per week, can be optimal for improving the symptoms of typical DES. These results provide useful information for guiding acupuncture in clinical trials for DES.
以往的荟萃分析表明，在治疗典型干眼综合征（DES）方面，针灸优于人工泪液。然而，鉴于荟萃分析纳入的随机对照试验（RCT）中针灸方案差异很大，因此有必要制定针灸指南。因此，通过对典型DES患者的RCT进行荟萃分析，研究了改善泪膜破裂时间（BUT）或泪液分泌试验（STT）的最佳针灸方案。检索了截至2018年6月的八个数据库，纳入21项RCT（n = 1542只眼），比较针灸与人工泪液对照的有效性。采用Bucher分析的间接比较方法，通过比较纳入和排除某些特定穴位（SAP）的RCT亚组之间的结果，找出改善BUT或STT的特定穴位。基于SAP数量对RCT亚组的结果进行荟萃分析，网络荟萃分析用于使用SAP对各方案进行多个成对比较以产生相对效应。Bucher分析确定了9个对BUT或STT有积极影响的SAP，两个对BUT和STT改善均有作用的SAP之间的正相关关系提示了三个（“KI3-LI4-SP6”或“KI3-GB14-ST2”）或四个SAP（“KI3-BL1-EX-HN7-SP6”）的潜在组合。亚组荟萃分析显示，与人工泪液对照相比，在包含三个以上SAP的亚组中，BUT或STT的改善取决于SAP。荟萃回归和网络荟萃分析揭示了SAP数量与BUT和STT改善之间的显著相关性，并表明使用四个SAP进行21 - 30天的针灸，尤其是每周两到三次，可能是改善典型DES症状的最佳方法。这些结果为DES临床试验中的针灸指导提供了有用信息。
