【摘要】 目的:应用Meta分析方法,系统评价针刺治疗偏头痛的疗效和分析国内外评价疗效差异的原因。方法:检索Pubmed、Cochrane Library、中国生物医学文献数据库(CBM)等数据库,筛选针刺治疗偏头痛的随机对照临床试验(randomized controlled trials,RCT),应用Cochrane协作网提供的Rev Man 5.0软件进行统计分析。结果:本研究共纳入12篇高质量的、以假针刺组为对照的RCT。Meta分析结果显示:针刺治疗结束时,真针刺和假针刺组的有效率分别为49.5%和43.3%,两组之间有统计学差异(OR=1.28,95%CI:1.02~1.61,P=0.03);随访结束时,两组的有效率分别为47.7%和38.5%,两组间无统计学差异(OR=1.33,95%CI:0.70~2.51,P=0.39)。对国内及国外临床试验进行亚组分析发现,在治疗结束及随访结束时,国内试验针刺组的有效率均显著高于假针刺组(P<0.05),而国外临床试验均显示两组间无统计学意义(P>0.05)。结论:上述结果提示在治疗期间针刺对偏头痛具有一定疗效,但治疗停止的随访期间针刺的疗效不显著。国内外临床试验在设计及执行等方面差异较大,今后尚需更多科学严谨的、符合中医特点的高质量RCT来验证针刺治疗偏头痛的疗效。更多还原

【Abstract】 AIM: To precisely assess the efficacy of acupuncture in migraine therapy,and analyze the reasons of different conclusions between domestic and foreign clinical trails. METHODS: Pubmed,Cochrane Library,and Chinese Biomedical Literature Database(CMB) were searched to obtain the randomized controlled trials(RCTs) of acupuncture for the treatment of migraine.Data were synthesized using RevMan 5.0 software provided by the Cochrane Collaboration.RESULTS:Twelve high-quality RCTs comparing verum acupuncture with sham acupuncture were included in the meta-analysis.The results showed that at the end of treatment the responder rate of verum and sham acupuncture were 49.5% and 43.3%,respectively.Acupuncture treatment could significantly reduced the severity of migraine by increasing responder rate(OR=1.28,95%CI: 1.02-1.61,P=0.03).The responder rate of verum and sham acupuncture at the end of follow-up were 47.7% and 38.5%,respectively,but the difference between them was not significant(OR=1.33,95%CI: 0.70-2.51,P=0.39).In subgroup analysis,RCTs in China showed significantly amelioration of migraine by acupuncture either at the end of treatment or follow-up(P<0.05),while RCTs in abroad showed no significant difference between two groups at the end of treatment or follow-up(P>0.05).CONCLUSION: The meta-analysis suggested that acupuncture was effective in the treatment of migraine but the effectiveness was not maintained after the withdrawal of acupuncture therapy.Since the conclusions of RCTs conducted in China and abroad are quite different,more full-scale RCTs following the principles of traditional Chinese medicine are recommended to further warrant the effectiveness of acupuncture.更多还原