Khatami Shabnam, Rahimzade Maryam, Lavari Narges, Jadidi Taha, Adel-Mehraban Mohammad Sadegh
Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Traditional Persian Medicine and Complementary Medicine (PerCoMed) Student Association, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Public Health. 2024 Dec;53(12):2683-2693.
Phlebotomy has been used as a non-pharmacological treatment for different types of diseases, regarding the philosophy of humors in traditional medicines, such as Persian Medicine. However, according to the narrow-approved indications for phlebotomy in Western Medicine, we aimed to systematically summarize high-level of evidence on safety and efficacy of phlebotomy in treatment of human diseases.
In this umbrella review, to identify meta-analysis studies of clinical trials on phlebotomy, four electronic databases, including PubMed, web of science, Scopus, and Cochran library were searched until Jun 18, 2022 with relevant keywords for 'phlebotomy' and 'meta-analysis' according to PRISMA guidelines and PICO questions. After excluding irrelevant studies, data on subject characteristics, method of intervention, and adverse events were extracted. To evaluate the quality of the methodology of the systematic reviews, AMSTAR2 scale was utilized.
From 327 identified studies, 7 full texts met the inclusion criteria, consisting of 56 clinical trials on 5648 subjects. These meta-analysis studies reported effects of phlebotomy on hypertension, acute gouty arthritis, skin disease (chronic urticaria and porphyria), and liver diseases (non-alcoholic fatty liver disease, chronic hepatitis C, and liver surgery). Our results showed significant improvements in different outcomes, while the most common adverse event was hematoma.
The level of evidence on the efficacy and safety of phlebotomy in some specific health conditions was substantial; however, to investigate the efficacy and safety of phlebotomy in management of other health problems more clinical studies with high sample sizes are needed.
放血疗法作为一种非药物治疗方法，已被应用于治疗不同类型的疾病，这与传统医学（如波斯医学）中的体液学说有关。然而，根据西医对放血疗法批准的适应症范围较窄，我们旨在系统总结放血疗法治疗人类疾病安全性和有效性的高级别证据。
在本系统评价中，为了识别关于放血疗法的临床试验的荟萃分析研究，我们根据PRISMA指南和PICO问题，使用相关关键词“放血疗法”和“荟萃分析”，检索了四个电子数据库，包括PubMed、科学网、Scopus和Cochrane图书馆，检索截止到2022年6月18日。在排除无关研究后，提取了关于受试者特征、干预方法和不良事件的数据。为了评估系统评价方法的质量，使用了AMSTAR2量表。
从327项已识别的研究中，7篇全文符合纳入标准，包括对5648名受试者进行的56项临床试验。这些荟萃分析研究报告了放血疗法对高血压、急性痛风性关节炎、皮肤病（慢性荨麻疹和卟啉病）以及肝脏疾病（非酒精性脂肪性肝病、慢性丙型肝炎和肝脏手术）的影响。我们的结果显示在不同结局方面有显著改善，而最常见的不良事件是血肿。
放血疗法在某些特定健康状况下的疗效和安全性证据水平较高；然而，为了研究放血疗法在管理其他健康问题方面的疗效和安全性，需要更多大样本量的临床研究。
