Wang Jixuan, Fan Shun, Su Kaihan, Zhang Jiacheng, Lu Xuanjun, Guo Shengxuan, Hu Siyuan
Department of Clinical Trial Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
Front Med (Lausanne). 2025 Jul 16;12:1626830. doi: 10.3389/fmed.2025.1626830. eCollection 2025.
This study aims to investigate the efficacy and safety of acupuncture and related therapies as an adjunct to standard treatment (ST) in children with asthma.
Randomized controlled trials (RCTs) comparing acupuncture combined with ST versus ST alone for pediatric asthma have been included. 8 databases and 3 clinical trial registries were searched, with the search completed up to January 31, 2025. The risk of bias in the included studies was assessed using the Risk of Bias 2 (RoB 2) tool. Data from the included studies were analyzed using R software version 4.4.2. The quality of evidence was evaluated using the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
A total of 16 randomized controlled trials involving 1,675 participants have been included. Compared to ST, the addition of acupuncture has significantly improved the percent predicted values of forced expiratory volume in 1 second (FEV1pred%) [MD = 6.02, 95% CI (1.28, 10.76), = 0.0128], No significant effect on forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) has been observed [MD = 3.36, 95% CI (-0.76, 7.48), = 0.1097]. In addition, acupuncture has significantly reduced serum immunoglobulin E (IgE) levels [SMD = -0.88, 95% CI (-1.21, -0.55), < 0.0001]. It has significantly increased serum immunoglobulin A (IgA) levels [MD = 0.31, 95% CI (0.22, 0.41), < 0.0001]. It has also significantly improved serum immunoglobulin G (IgG) levels [MD = 1.71, 95% CI (1.39, 2.02), < 0.0001]. Acupuncture has significantly increased peak expiratory flow (PEF) [MD = 3.15, 95% CI (1.16, 5.14), = 0.0019]. It has significantly reduced serum interleukin-4 (IL-4) levels [SMD = -2.40, 95% CI (-2.75, -2.05), < 0.0001]. Acupuncture has significantly decreased eosinophil (EOS) levels [MD = -1.06, 95% CI (-1.68, -0.43), = 0.0010]. However, acupuncture has shown no significant effect on the pediatric asthma quality of life questionnaire (PAQLQ) scores [MD = 0.01, 95% CI (-0.39, 0.40), = 0.9778].
Acupuncture has shown positive effects on certain serum immune and inflammatory biomarkers and FEV1 in pediatric asthma. It has not shown beneficial effects on FEV1/FVC. A substantial proportion of the evidence has been of low quality, and confidence in the results has been downgraded due to a serious risk of bias and inconsistency. The actual effects may differ substantially from the findings of this study. High-quality randomized controlled trials are still needed to confirm these findings in the future.
本研究旨在探讨针灸及相关疗法作为标准治疗（ST）辅助手段治疗儿童哮喘的疗效和安全性。
纳入比较针灸联合ST与单纯ST治疗小儿哮喘的随机对照试验（RCT）。检索了8个数据库和3个临床试验注册库，检索截至2025年1月31日。使用偏倚风险2（RoB 2）工具评估纳入研究的偏倚风险。使用R软件4.4.2版对纳入研究的数据进行分析。采用推荐分级、评估、制定与评价（GRADE）方法评估证据质量。
共纳入16项随机对照试验，涉及1675名参与者。与ST相比，加用针灸显著提高了第1秒用力呼气量预测值百分比（FEV1pred%）[MD = 6.02，95%CI（1.28，10.76），P = 0.0128]，未观察到对第1秒用力呼气量/用力肺活量（FEV1/FVC）有显著影响[MD = 3.36，95%CI（-0.76，7.48），P = 0.1097]。此外，针灸显著降低了血清免疫球蛋白E（IgE）水平[SMD = -0.88，95%CI（-1.21，-0.55），P < 0.0001]。显著提高了血清免疫球蛋白A（IgA）水平[MD = 0.31，95%CI（0.22，0.41），P < 0.0001]。还显著提高了血清免疫球蛋白G（IgG）水平[MD = 1.71，95%CI（1.39，2.02），P < 0.0001]。针灸显著增加了呼气峰值流速（PEF）[MD = 3.15，95%CI（1.16，5.14），P = 0.0019]。显著降低了血清白细胞介素-4（IL-4）水平[SMD = -2.40，95%CI（-2.75，-2.05），P < 0.0001]。针灸显著降低了嗜酸性粒细胞（EOS）水平[MD = -1.06，95%CI（-1.68，-0.43），P = 0.0010]。然而，针灸对儿童哮喘生活质量问卷（PAQLQ）评分未显示出显著影响[MD = 0.01，95%CI（-0.39，0.40），P = 0.9778]。
针灸对小儿哮喘的某些血清免疫和炎症生物标志物及FEV1显示出积极作用。对FEV1/FVC未显示有益作用。大部分证据质量较低，由于存在严重的偏倚风险和不一致性，对结果的信心已被下调。实际效果可能与本研究结果有很大差异。未来仍需要高质量的随机对照试验来证实这些发现。
