耳穴刺激对体重及肥胖相关参数的影响：随机对照临床试验的系统评价与荟萃分析
Effects of auricular stimulation on weight- and obesity-related parameters: a systematic review and meta-analysis of randomized controlled clinical trials.
作者信息
Hua Kevin, Usichenko Taras, Cummings Mike, Bernatik Miriam, Willich Stefan N, Brinkhaus Benno, Dietzel Joanna
机构信息
Institute for Social Medicine, Epidemiology and Health Economics, Charité - University Medicine, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Department for Anaesthesiology, University Hospital Greifswald, Greifswald, Germany.
出版信息
Front Neurosci. 2024 Aug 6;18:1393826. doi: 10.3389/fnins.2024.1393826. eCollection 2024.
BACKGROUND
Over the last three decades, the number of randomized controlled trials (RCTs) using stimulation of auricular vagal sensory nerves by means of electrical stimulation, auricular acupuncture, or acupressure to support weight loss has increased markedly. This systematic review focuses on the effects of auricular stimulation (AS) on anthropometric parameters and obesity-related blood chemistry.
METHODS AND ANALYSIS
The following databases were searched until November 2021: MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science, and Scopus Database. Data collection and analysis were conducted by two reviewers independently. Quality and risk assessment of included studies was performed using the risk of bias tool of the Cochrane Handbook, and the meta-analysis of the effect of the most frequently assessed biomarkers was conducted using the statistical software RevMan.
RESULTS
The full texts of 1,274 studies were screened; 22 contained data on obesity-related outcomes, and 15 trials with 1,333 patients were included in the meta-analysis. The overall quality of the included trials was moderate. AS significantly reduced body mass index (BMI) (mean difference (MD) = -0.38 BMI points, 95% CI (-0.55 to -0.22), < 0.0001), weight (MD = -0.66 kg, 95% CI (-1.12 to -0.20), = 0.005), waist circumference (MD = -1.44 cm, 95% CI (-2.69 to -0.20), = 0.02), leptin, insulin, and HOMA insulin resistance compared to controls. No significant reduction was found in body fat, hip circumference, ratio of waist/hip circumference, cholesterol, LDL, triglycerides, adiponectin, ghrelin, and glucose levels. The AS was safe throughout the trials, with only minor adverse reactions.
CONCLUSION
The study results suggest that a reduction of weight and BMI can be achieved by AS in obese patients; however, the size of the effect does not appear to be of clinical relevance. The effects might be underestimated due to active sham trials.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021231885.
背景
在过去三十年中，使用电刺激、耳针或指压刺激耳迷走感觉神经以辅助减肥的随机对照试验（RCT）数量显著增加。本系统评价聚焦于耳穴刺激（AS）对人体测量参数和肥胖相关血液生化指标的影响。
方法与分析
检索了以下数据库直至2021年11月：医学主题词表（MEDLINE，通过PubMed获取）、荷兰医学文摘数据库（EMBASE）、Cochrane对照试验中心注册库（CENTRAL）、科学引文索引（ISI）网络版数据库以及Scopus数据库。由两名 reviewers 独立进行数据收集和分析。使用Cochrane手册的偏倚风险工具对纳入研究进行质量和风险评估，并使用统计软件RevMan对最常评估的生物标志物的效应进行荟萃分析。
结果
筛选了1274项研究的全文；22项包含与肥胖相关结局的数据，15项试验共1333例患者被纳入荟萃分析。纳入试验的总体质量为中等。与对照组相比，AS显著降低了体重指数（BMI）（平均差（MD）=-0.38个BMI单位，95%置信区间（CI）为（-0.55至-0.22），P<0.0001）、体重（MD=-0.66kg，95%CI为（-1.12至-0.20），P=0.005）、腰围（MD=-1.44cm，95%CI为（-2.69至-0.20），P=0.02）、瘦素、胰岛素和稳态模型评估的胰岛素抵抗（HOMA-IR）。在体脂、臀围、腰臀比、胆固醇、低密度脂蛋白、甘油三酯、脂联素、胃饥饿素和血糖水平方面未发现显著降低。在整个试验过程中，AS是安全的，仅有轻微不良反应。
结论
研究结果表明，肥胖患者通过AS可实现体重和BMI的降低；然而，效应大小似乎不具有临床相关性。由于主动安慰剂对照试验，这些效应可能被低估。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021231885 。
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