Li Haiping, Wang Xuesong, Wang Yu, Gao Yuanbo, Zheng Xiaojun, Zhang Xifen, Li Xuxin, Zheng Xihui, Fan Xisheng, Zuo Guang, She Yanfen
College of Acupuncture-Moxibustion and Tuina, Hebei University of Chinese Medicine, Shijiazhuang City, Hebei Province, People's Republic of China.
Hebei International Joint Research Center for Dominant Diseases in Chinese Medicine and Acupuncture, Hebei University of Chinese Medicine, Shijiazhuang City, Hebei Province, People's Republic of China.
J Pain Res. 2024 Oct 2;17:3197-3216. doi: 10.2147/JPR.S488343. eCollection 2024.
Acupuncture and related therapies are effective and safe ways to relieve the pain, and improve the health and quality of life in women with endometriosis-related pain. However, it is still unclear which treatment is the most effective. Our study aims to summarize the evidence and determine the most effective and safe method to treat the endometriosis.
We searched PubMed, EMBASE, Cochrane Library, and Web of science, China Biology Medicine, China National Knowledge Infrastructure, Wan fang Data, Chinese Scientific Journal Database and conducted manual searches of relevant papers, summarized randomized clinical trials of acupuncture-related therapies for endometriosis from database inception to 21 April 2024. After independent literature screening and data extraction that pain VAS was selected as the primary outcome measure. The quality evaluation was conducted by Review Manager 5.4. Perform network meta-analysis (NMA) used Stata 15.0 software.
Forty-two eligible trials involving six acupuncture-related interventions and 3,635 participants were included in this NMA. Pairwise meta-analyses show that combination therapy was more efficacious than western medicine and Chinese herb medicine for pain VAS scores, serum CA125 level and response rate results. The NMA estimates indicated that: for pain VAS scores, acupuncture (SMD: -2.33; 95% CI: -4.37, -0.29) and combination therapy (SMD: 1.79 95% CI: 1.21, 2.41) were superior to western medicine. For serum CA125 level, acupoint application (SMD: -11.33 95% CI: -20.28, -2.97) and combination therapy (SMD: 6.20; 95% CI: 1.60, 10.75) were associated with better efficacy when considered alongside western medicine. For response rate, combination therapy (SMD: 0.20; 95% CI: 0.14, 0.29) and auricular therapy (SMD: 8.01; 95% CI: 2.08, 45.37) were more efficacious than western medicine. The comprehensive ranking results show that acupoint catgut embedding was the best performing at lowering pain VAS scores, acupoint application was identified as the most effective in reducing serum CA125 level, and auricular therapy was ranked first in improving the response rate.
Acupoint catgut embedding, auricular therapy, acupoint application and combination therapy may be the best solutions for the treatment of endometriosis. Additional trials are needed to develop higher-quality evidence and optimal regimens.
针灸及相关疗法是缓解疼痛、改善子宫内膜异位症相关性疼痛女性健康和生活质量的有效且安全的方法。然而，哪种治疗方法最有效仍不清楚。我们的研究旨在总结证据并确定治疗子宫内膜异位症最有效且安全的方法。
我们检索了PubMed、EMBASE、Cochrane图书馆、科学网、中国生物医学数据库、中国知网、万方数据、维普资讯，并对手稿进行了人工检索，总结了从数据库建立到2024年4月21日关于子宫内膜异位症的针灸相关疗法的随机临床试验。经过独立的文献筛选和数据提取，选择疼痛视觉模拟评分（VAS）作为主要结局指标。使用Review Manager 5.4进行质量评估。使用Stata 15.0软件进行网状Meta分析（NMA）。
该NMA纳入了42项合格试验，涉及六种针灸相关干预措施和3635名参与者。成对Meta分析表明，在疼痛VAS评分、血清CA125水平和有效率结果方面，联合治疗比西药和中药更有效。NMA估计表明：对于疼痛VAS评分，针灸（标准化均数差：-2.33；95%可信区间：-4.37，-0.29）和联合治疗（标准化均数差：1.79；95%可信区间：1.21，2.41）优于西药。对于血清CA125水平，与西药相比，穴位敷贴（标准化均数差：-11.33；95%可信区间：-20.28，-2.97）和联合治疗（标准化均数差：6.20；95%可信区间：1.60，10.75）疗效更好。对于有效率，联合治疗（标准化均数差：0.20；95%可信区间：0.14，0.29）和耳穴疗法（标准化均数差：8.01；95%可信区间：2.08，45.37）比西药更有效。综合排名结果显示，穴位埋线在降低疼痛VAS评分方面表现最佳，穴位敷贴被确定为降低血清CA125水平最有效的方法，耳穴疗法在提高有效率方面排名第一。
穴位埋线、耳穴疗法、穴位敷贴和联合治疗可能是治疗子宫内膜异位症的最佳方案。需要更多试验以得出更高质量的证据和优化方案。
