基于网络Meta分析评价穴位刺激疗法治疗早发性卵巢功能不全临床疗效的系统评价

摘要

目的 系统评价以穴位刺激疗法为主治疗早发性卵巢功能不全(POI)的有效性和安全性.方法 计算机检索PubMed、Embase、Cochrane Library、web of science、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方(WanFang)和维普(VIP)数据库,搜集有关穴位刺激疗法治疗POI的随机对照试验.用软件R 3.40和软件stata 14.0完成直接比较的meta分析和网状meta分析,用RevMan5.3作风险偏倚图.结果 最终纳入43个RCTs,共计3046例POI患者,涉及穴位刺激疗法及其综合疗法1 8种.Meta分析显示:①穴位刺激疗法(RR=1.25,95％CI[1.07,1.45])、穴位刺激疗法+中药(RR=1.25,95％CI[1.18,1.32])及穴位刺激疗法+激素补充治疗(HRT)(RR=1.20,95％CI[1.12,1.29])的治疗效果均优于HRT,差异均具有统计学意义(Z=2.90,P=0.04;Z=7.56,P＜0.00001;Z=4.06,P＜0.000 01).②与HRT比较,穴位刺激疗法的不良反应发生率较小,安全性优于HRT (RR=0.18,95％CI[0.08,0.41]),差异具有统计学意义(Z=4.08,P＜0.0001).网状meta分析共产生42个直接比较,共产生1 1 0个间接比较,其中38个比较具有统计学意义.以HRT为参照的网状Meta分析结果显示:疗效排秩前3位的治疗措施依次为:穴位埋线、艾灸、温针灸,均为单一治疗措施,未体现综合疗法的优势,HRT在1 8种治疗措施中排序位于第17位.结论 基于目前的证据,穴位刺激疗法治疗POI具有较好的临床疗效,且安全性较HRT好,疗效排序前3位的穴位刺激疗法效果更显著,但远期疗效以及对卵巢功能的影响需要进一步研究.另外本研究结论仍需要大量设计合理、方法得当的RCT给予证实.%Objective To systematically evaluate the effectiveness and safety of acupoint stimulation therapy for treatment of premature ovarian insufficiency (POI).Methods Computer retrieval was carried out in such databases as PubMed,Embase,Cochrane Library,web of science,Chinese biomedicine database (CBM),China National Knowledge Infrastructure (CNKI),WanFang and VlP in order to collect the randomized controlled trials (RCT) concerning acupoint stimulation therapy for treatment of POI.Software R 3.40 and stata 14.0 were used for Meta-analysis and network Meta-analysis,and RevMan 5.3 was used for plotting the risk bias diagrams.Results Fortythree RCTs were included in total,involving 3046 POI patients and 18 acupoint stimulation therapies and comprehensive therapies.Metaanalysis showed:① The curative effects of acupoint stimulation therapy (RR=1.25,95％CI [L07,1.45]),acupoint stimulation therapy+Chinese herbal medicine (RR=1.25,95％CI [1.18,1.32]) and acupoint stimulation therapy+hormone replacement therapy (HRT) (RR=1.20,95％CI [1.12,1.29]) were all superior to that of HRT,indicating that the differences were statistically significant (Z=2.90,P=0.04;Z=7.56,P＜0.000 01;Z=4.06,P＜0.000 01).② Compared with HRT,the occurrence rate of adverse effect of acupoint stimulation therapy was lower,and the safety was superior to that of HRT (RR=0.18,95％CI [0.08,0.41]),indicating that the differences were statistically significant (Z=4.08,P＜0.000 1).Forty-two direct comparisons and 110 indirect comparisons were generated according to network Meta-analysis,among which,38 comparisons were statistically significant.Network Metaanalysis results with HRT as control showed:the therapeutic measures ranking top 3 according to the curative effect sequence were catgut embedment in acupoint,moxibustion and warming-needle moxibustion,successively,and all the 3 measures were monotherapies without reflecting the advantages of comprehensive therapy.HRT ranked 17th among the 18 included therapeutic measures.Conclusion On the basis of current evidences,acupoint stimulation therapy has a better clinical efficacy and safety for treatment of POI when compared with HRT.The acupoint stimulation therapies ranking the top 3 have more significant curative effects,but the long-term efficacy and the effect on the ovarian function still need to be further explored.In addition,the conclusion of this study still needs to be verified through a large number of RCTs with reasonable designs and appropriate methods.