针刺治疗儿童遗尿症的系统评价与Meta分析

Acupuncture for treatment of nocturnal enuresis in children：a systematic review and Meta-analysis

关键词:  针刺  遗尿  Meta 分析  随机对照试验

Key words:  acupuncture  nocturnal enuresis  Meta-analysis  randomized controlled trials

摘要:

[目的] 系统评价针刺治疗儿童遗尿症的有效性和安全性。[方法] 通过检索 MEDLINE、The Cochrane Central Register of Controlled Trials（CENTRAL）、EMBASE、中国生物医学文献数据库（CBM）等中英文数据库，搜集针刺治疗儿童遗尿症的随机对照研究（RCT），检索时限设定为从建库至 2021年8月12日。按照Cochrane Handbook 5.1的标准，经过两位评价员独立进行文献筛选和资料提取，并对纳入研究的偏倚风险进行评价后，采用 Revman 5.3软件进行Meta分析。[结果] 共纳入11项RCT，共纳入受试者1 013例，其中针刺组521例，对照组492例。Meta分析结果显示：与对照组相比，针刺可显著提高儿童遗尿症的治愈率[OR=2.43，95%CI（1.37，4.29），P=0.002，I²=69%]，并分别优于中药组和安慰针刺组，但与西药组无显著差异。此外，尽管针刺组与对照组总体相比，并未能显著降低患儿平均遗尿发作次数，但与安慰针刺组对比，针刺组具有显著治疗优势[MD=-1.49，95%CI（-2.26，-0.72），P=0.000 2]。在不良事件风险方面，针刺组与对照组之间无显著性差异[OR=0.62，95%CI（0.04，8.72），P=0.72]。[结论] 现有证据表明，针刺疗法在对儿童遗尿症的治愈率方面较中药及安慰针刺更有效，但与西药相似；针刺在改善患儿每周平均遗尿次数方面，对比安慰针刺有更好的疗效。针刺具有与这些疗法相似的安全性。

Abstract:

[Objective] This study aims to systematically review the efficacy and safety of acupuncture on nocturnal enuresis in children.[Methods] We performed a comprehensive search of medical literature,including Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE,EMBASE,CBM,and other databases. The date of the latest search of all databases was August 12th,2021. After two reviewers screened the studies,extracted data from including studies,and rated the quality of evidence independently,we performed meta-analysis using software of Revman version 5.3.[Results] A total of 11 studies with 1 013 randomized participants(521 in acupuncture group and 492 in control group) were included. The results of meta-analysis showed that,compared with the control group,the acupuncture group had statistically significant higher complete response rate[OR=2.43,95%CI(1.37,4.29),P=0.002,I²=69%],so did the statistical significance when compared with sham acupuncture group and herbal therapy group respectively. But there was no significant difference between acupuncture group and conventional drug group. Moreover,although acupuncture did not reduce the average number of nocturnal enuresis in comparison with control intervention,a significant decrease was found when compared to the placebo acupuncture[MD=-1.49,95%CI(-2.26,-0.72),P=0.000 2]. In terms of adverse events,there was no significant difference between acupuncture group and control group[OR=0.62,95%CI(0.04,8.72),P=0.72].[Conclusion] The existing evidence shows that acupuncture is more effective than traditional Chinese medicine and placebo acupuncture in the complete response rate of nocturnal enuresis in children,but it is similar when compared to conventional drug group. Acupuncture has a better effect than placebo acupuncture in improving the average number of enuresis per week. And acupuncture has similar safety compared to all these treatments.