Clinical School of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
Clinical School of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China; Guangdong Provincial Key Laboratory of Sensor Technology and Biomedical Instrument, Guangzhou, China.
Complement Ther Med. 2023 Nov;78:102988. doi: 10.1016/j.ctim.2023.102988. Epub 2023 Sep 23.
The purpose of this study was to assess the efficacy and safety of acupuncture at Sifeng for pediatric anorexia.
The randomized controlled trials (RCTs) of acupuncture at Sifeng for pediatric anorexia from their beginning to October 2022 were looked up in the seven databases. The Cochrane risk of bias evaluation tool was applied to the risk of bias analysis of the included studies. A meta-analysis of the total efficiency, score of food intake reduction, time to normalize food intake, body weight, leptin levels, and blood zinc levels was performed using Review Manager 5.3 software. The GRADE criteria were applied to assess the evidence's quality.
A total of 24 RCTs were included, involving 2202 children. The allocation of concealment, blinding, and selective reporting has a high or unclear risk of bias. All experiments compared acupuncture at Sifeng with traditional Chinese medicine or Western medicine. The results showed that, compared with medicine, acupuncture at Sifeng could significantly improve the total efficiency (OR=6.44, 95%CI [4.78,8.66]), lower the score of food intake reduction (MD=-0.69, 95%CI [-1.00, -0.39]), decrease leptin levels (MD=-5.19, 95%CI [-8.09, -2.29]) and time to normal food intake (MD=-2.22, 95%CI [-2.42, -2.01]), increase blood zinc (MD=0.79, 95%CI [0.21, 1.37]) and body weight (MD=1.28, 95%CI [0.85, 1.72]). Seven studies found that the treatment was safe both during and after. Based on the GRADE criteria, the quality of the evidence for the majority of indicators was extremely poor.
The low certainty of evidence suggested that acupuncture at Sifeng was effective and safe in the therapy of pediatric anorexia. Future high-quality clinical studies are needed to provide more reliable evidence of the effectiveness and safety of the therapy.
本研究旨在评估针刺四缝穴治疗小儿厌食症的疗效和安全性。
检索从建库至 2022 年 10 月发表的针刺四缝穴治疗小儿厌食症的随机对照试验（RCT），采用 Cochrane 偏倚风险评估工具对纳入研究进行偏倚风险分析，采用 Review Manager 5.3 软件对总有效率、食量减少评分、食量恢复正常时间、体质量、瘦素水平、血锌水平进行 Meta 分析，采用 GRADE 证据质量评价标准评价证据质量。
共纳入 24 项 RCT，涉及 2202 例患儿。分配隐藏、盲法和选择性报告存在高或不明确偏倚风险。所有试验均将针刺四缝穴与中药或西药进行比较。结果显示，与药物相比，针刺四缝穴可显著提高总有效率[OR=6.44，95%CI（4.78，8.66）]，降低食量减少评分[MD=-0.69，95%CI（-1.00，-0.39）]，降低瘦素水平[MD=-5.19，95%CI（-8.09，-2.29）]和食量恢复正常时间[MD=-2.22，95%CI（-2.42，-2.01）]，升高血锌水平[MD=0.79，95%CI（0.21，1.37）]和体质量[MD=1.28，95%CI（0.85，1.72）]。7 项研究发现治疗过程中和治疗后均安全。基于 GRADE 标准，大多数指标的证据质量均为极低质量。
证据的确定性低表明，针刺四缝穴治疗小儿厌食症有效且安全，但仍需开展高质量的临床研究，提供更可靠的疗效和安全性证据。
