Li Ting, Yu Mingchen, Han Lulu, Feng Bo, Sun Fenglei
The First Clinical School of Shandong University of Chinese Medicine, Jinan, China.
Rizhao Hospital of Traditional Chinese Medicine, Rizhao, Shandong, China.
Front Med (Lausanne). 2023 Jul 31;10:1196357. doi: 10.3389/fmed.2023.1196357. eCollection 2023.
To date, several systematic reviews and/or meta-analyses (SRs/MAs) on the topic of acupuncture as a treatment for diabetic gastroparesis (DGP) have been published. However, whether acupuncture is an effective and safe treatment for DGP remains controversial. In this study, we aimed to determine whether the methodology and results of previously published SRs/MAs of acupuncture as a treatment for DGP were of sufficient quality to be considered reliable.
We extensively searched seven databases, including PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge, Wan Fang, and Chongqing VIP, for SRs/MAs published before or on September 16, 2022. The SRs/MAs that met the inclusion criteria were evaluated for the quality of the methodology and results using the Assessing the Methodological Quality of Systematic Reviews Two (AMSTAR-2) and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tools. A re-meta-analysis of primary outcome indicators was also performed.
Ten SRs/MAs that met the inclusion criteria were obtained. Using the AMSTAR-2, which is a methodological quality assessment tool, two MAs were rated as low quality, and eight SRs/MAs were rated as extremely low quality. Assessment with the GRADE tool revealed that, among 20 results, 4 were of moderate quality, 10 were of low quality, and 6 were of very low quality. Re-meta-analysis of primary outcome indicators revealed that, in terms of total efficiency, all types of acupuncture interventions, such as acupuncture, electroacupuncture, and acupoint injection, performed better than the controls, such as gastroprokinetic agents and sham acupuncture. Moreover, in the treatment of DGP, acupuncture exhibited fewer side effects compared to the controls.
Acupuncture appears to improve the symptoms of patients with DGP, and the side effects of acupuncture as a treatment for DGP are inferior to those of the controls. However, owing to the low quality of the methodology and results of the SRs/MAs, these findings cannot be considered reliable and need to be validated by additional studies with rigorous standards of experimental design and protocols and larger sample sizes.
迄今为止，已经发表了几篇关于针灸治疗糖尿病胃轻瘫（DGP）的系统评价和/或荟萃分析（SRs/MAs）。然而，针灸是否是治疗DGP的有效且安全的方法仍存在争议。在本研究中，我们旨在确定先前发表的关于针灸治疗DGP的SRs/MAs的方法和结果是否具有足够的质量以被认为是可靠的。
我们广泛检索了七个数据库，包括PubMed、EMBASE、Cochrane图书馆、科学网、中国知网、万方和重庆维普，以获取2022年9月16日之前或当日发表的SRs/MAs。使用系统评价方法学质量评估工具二（AMSTAR - 2）和推荐分级、评估、制定与评价（GRADE）工具对符合纳入标准的SRs/MAs的方法和结果质量进行评估。还对主要结局指标进行了再荟萃分析。
获得了10篇符合纳入标准的SRs/MAs。使用方法学质量评估工具AMSTAR - 2，两项荟萃分析被评为低质量，八项SRs/MAs被评为极低质量。使用GRADE工具评估显示，在20项结果中，4项为中等质量，10项为低质量，6项为极低质量。对主要结局指标的再荟萃分析显示，就总有效率而言，所有类型的针灸干预措施（如针刺、电针和穴位注射）均比对照组（如促胃肠动力药和假针刺）表现更好。此外，在DGP的治疗中，针灸与对照组相比副作用更少。
针灸似乎能改善DGP患者的症状，且针灸治疗DGP的副作用低于对照组。然而，由于SRs/MAs的方法和结果质量较低，这些发现不能被认为是可靠的，需要通过具有严格实验设计标准和方案以及更大样本量的额外研究来验证。
