针刺相关疗法治疗高脂血症的网状meta分析

王雪松; 王月燊; 李加加; 余超超; 吴淼; 孔立红

doi:10.1016/j.dcmed.2020.12.002

摘要:

目的比较不同针刺及针刺相关疗法对高脂血症患者的临床疗效并排序。

方法使用网状meta分析的方法来评价针刺相关疗法治疗高脂血症的直接和间接效果。计算机检索PubMed, EMBASE, Cochrane Library, 中国医学生物 (CBM), 中国知网 (CNKI), 万方和维普等数据库，搜集针灸相关疗法治疗高脂血症的随机对照试验(RCT)。由2位研究者独立筛选文献、提取数据和评价纳入研究的偏倚风险后，采用Stata 15.0和WinBUGS 1.4.3软件进行数据分析。

结果最终纳入36项合格的研究，共包括3124例高脂血症患者，涉及针灸相关疗法及综合疗法共12种。网状meta分析结果显示：对于胆固醇，穴位埋线、单纯针刺、穴位注射、电针、西药、联合疗法均比安慰剂的疗效更好(P < 0.05)；对于甘油三酯，单纯针刺、电针、温针灸、西药、联合疗法的疗效均优于安慰剂 (P < 0.05)，而温针灸优于中药 ( P < 0.05)；对于低密度脂蛋白，联合疗法疗效显著高于改变生活方式(P < 0.05)；对于高密度脂蛋白，温针灸治疗的效果优于耳穴、穴位埋线、单纯针刺、穴位注射、中药、电针、改变生活方式、艾灸、西药、联合疗法、安慰剂的疗效(P < 0.05)，其中西药和联合疗法均优于单纯针刺(P < 0.05)。综合排序结果显示，单纯针刺和联合疗法可能是最佳干预措施。

结论对于高脂血症的治疗，各类针刺相关疗法对高脂血症患者的疗效均比改变生活方式的疗效更好，单纯针刺和联合疗法可能是最佳干预措施。

Abstract:

ObjectiveTo compare and rank the clinical effects of different acupuncture and related therapies on hyperlipidemia patients.

MethodsWe used network meta-analysis (NMA) to evaluate direct and indirect effects in studies of acupuncture and related therapies for hyperlipidemia. Databases PubMed, EMBASE, Cochrane Library, the China Biology Medicine (CBM), the China National Knowledge Infrastructure (CNKI), Wanfang Data and the Chinese Scientific Journal Database (VIP) were searched to collect randomized controlled trials (RCTs) of acupuncture and related therapies in the treatment of hyperlipidemia. The data were analyzed using Stata 15.0 and WinBUGS 1.4.3 software after two researchers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies.

ResultsWe analyzed a total of 36 eligible studies that included 3 124 patients, involving 12 types of acupuncture and related therapies and comprehensive therapies. The results of the NMA showed that: for the total cholesterol (TC), acupoint catgut embedding (ACE), simple acupuncture (ACU), acupoint injection (AI), electroacupuncture (EA), western medicine of statins (WM), and combination of acupuncture and related therapies (combined therapies) were all more effective than placebo (P < 0.05). For triacylglycerol (TG), ACU, EA, warming acupunc-ture (WA), WM and combined therapies were better than placebo (P < 0.05), while WA was better than Chinese herb (CH) (P < 0.05). For low-density lipoprotein cholesterol (LDL-C), combined therapies were more effective than lifestyle modification (LM) (P < 0.05). For high-density lipoprotein choles-terol (HDL-C), auricular acupoint stimulation (AAS), ACE, ACU, AI, CH, EA, LM, moxibustion (MOX), WM, combined therapies and placebo were all worse than WA (P < 0.05), while WM and combined therapies were better than ACU (P < 0.05). Combined ranking results suggest that ACU and combined therapies may be the optimal intervention.

ConclusionsThe efficacy of all kinds of acupuncture-related therapies in patients with hyperlipidemia is better than lifestyle changes. However, for different outcome indicators, all kinds of acupuncture-related therapies have their advantages and disadvantages, and comprehensive ranking results suggest that ACU and combined therapies may be the optimal intervention.

针刺相关疗法治疗高脂血症的网状meta分析

Acupuncture and Related Therapies for Hyperlipidemia: A Network Meta-Analysis