针刺治疗干眼症的Meta分析

摘要

目的:根据系统综述和meta分析优先报告的条目(PRISMA)声明和Cochrane协作中心推荐的方法,严格评估和总结针刺治疗干眼症的随机对照试验的结果.方法:检索PubMed,Cochrane临床试验注册中心,ClinicalTrials.gov和Embase,以及中文、日文和韩文数据库,从建库时间到2016年8月.两位研究人员分别筛选RCTs并评估其方法学质量.采用Revman5.3和GRADE进行Meta分析和证据分级.结果:本系统评价共纳入8项试验,其方法学质量普遍偏低.随访3-10星期,与对照组相比,针刺治疗可以改善泪膜破裂时间(BUT,MD=1.33,95%CI=1.01-1.66,619例).针刺组和对照组之间Schirmer's试验的差值为1.73 mm(95%CI=1.28-2.18,618例).其他主观结局指标两组间无显著差异.结论:由于目前纳入的临床试验方法学质量较低,尚不能得出针刺治疗干眼症疗效的确切结论.针刺疗法可能对BUT和Schirmer's试验有一定影响,但是对主观症状无明显作用.设计严谨的大规模高质量随机对照试验将有助于明确针刺治疗干眼症的临床疗效.%Objective: To summarize and critically assess the evidence from randomized controlled trials (RCTs) of acupuncture in treating dry eye syndrome (DES) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Cochrane Collaboration recommendations. Methods: A search of PubMed, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Embase was made from their inception to August 2016, as well as Chinese, Japanese, and Korean databases. Two reviewers independently selected RCTs and assessed the methodological quality. Meta-analysis and the level of evidence were processed by RevMan 5.3 and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: After selection, 8 trials were subjected to our systematic review. The methodological quality was low generally. The 3-10 weeks follow-up showed that acupuncture improved the tear film break-up time (BUT) (MD=1.33, 95%CI=1.01-1.66, 619 participants). The mean difference of Schirmer's test was 1.73 mm (95%CI=1.28-2.18, 618 participants) between the acupuncture group and the control group. The subjective variables exhibited no significant differences. Conclusion: The low methodological quality of the trials does not suggest drawing firm conclusions on the value of acupuncture therapy for DES. Acupuncture treatment may have some effects on the tear film BUT and Schirmer's test, but not on the subjective symptoms. Well-planned large-scale high-quality RCTs are needed to make it clear whether acupuncture is effective in treating DES.