Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China.
Key Laboratory of Acupuncture for Senile Disease, Chengdu University of Traditional Chinese Medicine, Ministry of Education, Chengdu, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2024 Jul 26;19:1721-1739. doi: 10.2147/COPD.S464546. eCollection 2024.
Acupuncture has been used as an adjuvant therapy for Chronic obstructive pulmonary disease (COPD). However, systematic reviews (SRs) and meta-analyses (MAs) have reported inconsistent results and unknown quality. This overview aimed to summarize the current SRs/MAs to provide evidence for the effectiveness and safety of acupuncture in the treatment of COPD.
SRs/MAs were searched via eight databases from their establishment to December 31, 2023. The methodological quality was assessed by A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). The risk of bias was assessed using the Risk of Bias in Systematic Review (ROBIS) tool. The Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture (PRISMA-A) to evaluate the reporting quality. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to determine the strength of evidence. In addition, we also conducted an analysis of the acupuncture points used in the primary RCTs.
Twenty-two SRs/MAs were included in this overview. Based on the assessment using AMSTAR 2, nineteen SRs/MAs were "critically low". Eight SRs/MAs had a low risk of bias. Based on PRISMA-A, the reporting completeness of eighteen SRs/MAs were more than 70%. As for GRADE assessment, only three outcome measures were of high quality. COPD patients can benefit from moxibustion, acupoint application, acupoint catgut embedding, manual acupuncture, and electroacupuncture, as indicated by effectiveness in measures including lung function, 6MWD, mMRC, CAT, and acute exacerbation. In addition, the efficacy of TENS needed to be further demonstrated. The commonly used acupuncture points in the RCTs include BL13, BL23, and EX-B1.
Evidence from SRs showed that acupuncture is beneficial to lung function, acute exacerbation, 6MWD, mMRC and CAT. For SGRQ and brog scale, acupuncture should be used selectively, but this finding should still be taken with caution.
针灸已被用作治疗慢性阻塞性肺疾病（COPD）的辅助疗法。然而，系统评价（SRs）和荟萃分析（MAs）的结果并不一致，其质量也不确定。本综述旨在总结目前的 SRs/MAs，为针灸治疗 COPD 的有效性和安全性提供证据。
通过八个数据库从建立到 2023 年 12 月 31 日进行了 SRs/MAs 的检索。使用 A Measurement Tool to Assess Systematic Reviews 2（AMSTAR 2）评估方法学质量。使用 Risk of Bias in Systematic Review（ROBIS）工具评估偏倚风险。使用 Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture（PRISMA-A）评估报告质量。使用 Grading of Recommendations Assessment，Development and Evaluation（GRADE）评估证据强度。此外，我们还对主要 RCT 中使用的穴位进行了分析。
本综述纳入了 22 篇 SRs/MAs。根据 AMSTAR 2 的评估，有 19 篇 SRs/MAs 的“严重低质量”。8 篇 SRs/MAs 的偏倚风险较低。根据 PRISMA-A，18 篇 SRs/MAs 的报告完整性超过 70%。对于 GRADE 评估，只有 3 个结局指标为高质量。COPD 患者可以从艾灸、穴位敷贴、穴位埋线、手动针灸和电针中受益，这些方法在肺功能、6MWD、mMRC、CAT 和急性加重等指标上均有效。此外，还需要进一步证明 TENS 的疗效。RCT 中常用的穴位包括 BL13、BL23 和 EX-B1。
SR 证据表明，针灸对肺功能、急性加重、6MWD、mMRC 和 CAT 有益。对于 SGRQ 和 brog 量表，应选择性地使用针灸，但这一发现仍需谨慎对待。
