Yu Zhili, Chen Shumin, Zhang Qiao, Fu Wenbin, Geng Hongling, Wang Cong, Wen Hao
Department of Acupunctue-Moxibustion and Tuina, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
Department of Traditional Chinese Medicine, Wenquan Hospital of Guangdong Province Veteran Cadre Affairs Center, Guangzhou, China.
Medicine (Baltimore). 2025 Jun 13;104(24):e42812. doi: 10.1097/MD.0000000000042812.
The efficacy of acupuncture and moxibustion-related therapy (AMRT) on the glycolipid metabolism in patients with polycystic ovarian syndrome (PCOS), especially those with an obese phenotype, is still uncertain. This paper aims to analyze the impact of AMRT on glycolipid metabolism in managing obese-type PCOS.
This systematic review and meta-analysis synthesized evidence from randomized controlled trials on AMRT, compared to conventional western medicine or blank control for obese PCOS focusing on their glycolipid metabolism, searched across 7 databases. Direct and Indirect Meta-analysis was conducted using Review Manager 5.4 and R program, presenting continuous data as mean differences (MD) with 95% confidence intervals (CIs). The Cochrane risk-of-bias tool for trials 2 (ROB2) was used for methodological quality assessment, and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach evaluated the certainty of evidence.
Thirty randomized controlled trials were included. Compared to control treatments, AMRT significantly improved fasting plasma glucose (FPG) (MD = -0.19, 95% CI = -0.28 to -0.09, moderate certainty), Weight (W) (MD = -2.34, 95% CI = -4.51 to -0.17, moderate certainty) and triglycerides (TG) (MD = -0.35, 95% CI = -0.40 to -0.29, moderate certainty), and showed similar benefits for low-density lipoprotein (MD = -0.20, 95% CI = -0.40 to -0.01, moderate certainty) and total cholesterol (MD = -0.36, 95% CI = -0.49 to -0.23, moderate certainty). The other indicators were deemed unreliable or showed negative results. During network meta-analysis, Moxibustion combined with catgut embedding was the most effective measure in the improvement of FPG, fasting insulin (FIN) and insulin resistance (IR). Manual acupuncture combined with metformin ranked third improving BMI, TG and IR, while ranked first in waist-hip ratio (WHR). No statistical incoherence in all comparisons of direct with indirect evidence for efficacy and treatment discontinuation.
Acupuncture and related therapies can effectively improve glycolipid metabolism (FPG, W, total cholesterol, TG, low-density lipoprotein) in obese PCOS patients (moderate certainty evidence) and have a comparable effect to conventional medicine on improving IR (moderate certainty evidence). Among them, moxibustion plus catgut embedding was the most optimal AMRT on reducing blood glucose, while manual acupuncture combined with metformin was the best AMRT applying on ameliorating blood lipids.
针灸相关疗法（AMRT）对多囊卵巢综合征（PCOS）患者，尤其是肥胖型患者糖脂代谢的疗效仍不明确。本文旨在分析AMRT对肥胖型PCOS患者糖脂代谢的影响。
本系统评价和荟萃分析综合了关于AMRT的随机对照试验证据，与传统西医或空白对照相比，针对肥胖型PCOS患者的糖脂代谢进行研究，检索了7个数据库。使用Review Manager 5.4和R程序进行直接和间接荟萃分析，连续数据以均数差（MD）及95%置信区间（CI）表示。采用Cochrane试验偏倚风险工具2（ROB2）进行方法学质量评估，并采用推荐分级评估、制定和评价（GRADE）方法评估证据的确定性。
纳入30项随机对照试验。与对照治疗相比，AMRT显著改善了空腹血糖（FPG）（MD = -0.19，95%CI = -0.28至-0.09，中等确定性）、体重（W）（MD = -2.34，95%CI = -4.51至-0.17，中等确定性）和甘油三酯（TG）（MD = -0.35，95%CI = -0.40至-0.29，中等确定性），对低密度脂蛋白（MD = -0.20，95%CI = -0.40至-0.01，中等确定性）和总胆固醇（MD = -0.36，95%CI = -0.49至-0.23，中等确定性）也有类似益处。其他指标被认为不可靠或显示为阴性结果。在网状荟萃分析中，艾灸结合埋线是改善FPG、空腹胰岛素（FIN）和胰岛素抵抗（IR）最有效的措施。手针联合二甲双胍在改善BMI、TG和IR方面排名第三，在腰臀比（WHR）方面排名第一。在疗效和治疗中断的直接证据与间接证据的所有比较中均无统计学不一致性。
针灸及相关疗法可有效改善肥胖型PCOS患者的糖脂代谢（FPG、W、总胆固醇、TG、低密度脂蛋白）（中等确定性证据），在改善IR方面与传统药物效果相当（中等确定性证据）。其中，艾灸加埋线是降低血糖最优化的AMRT，而手针联合二甲双胍是改善血脂的最佳AMRT。
