背景:在中国,针灸已被广泛用于治疗肠易激综合征(IBS)。一些随机对照试验(RCTs)已经证明了它们的有效性,但它很少与一线解痉挛药进行比较以验证其有效性。因此,我们使用调整后的间接治疗比较荟萃分析,比较了针刺与解痉挛治疗IBS的疗效.方法:Embase,OVIDMedline,从开始到2022年3月14日,搜索了Cochrane中央对照试验登记册数据库,没有语言限制。纳入了将抗痉挛药或针灸与安慰剂或抗痉挛药之一进行比较的随机对照试验。感兴趣的主要结果是腹痛的改善。次要结果是整体IBS症状和不良事件的缓解。随机效应模型被用来汇集数据。效应大小通过标准化平均差(SMD)或相对比率来测量,并按P评分对针灸和不同止痉挛药的有效性进行排序。结果:纳入35个RCT(n=5,190)。分析表明,西美托,drotaverine,针灸,和pinarverium在缓解腹痛方面优于安慰剂;cimetropium(SMD,-3.00[95CI,-4.47至-1.53],P分数=0.99)排名最有效。在成对比较中,在缓解腹痛方面,针灸治疗效果优于除西咪嗪和屈他维林外的大多数解痉挛药,尽管组间差异在统计学上无统计学意义。在整体IBS症状缓解的连续结果分析中,结果表明,pinaverium更有效(SMD,1.72[95CI,0.53至2.92],P评分=0.90)比安慰剂。曲美布汀和针灸比安慰剂有更大的改善,但组间无显著差异。在成对比较中,针灸比匹维胺更有效(SMD,-1.11[95CI,-1.94至-0.28])缓解整体IBS症状。在分析不良事件时,针灸的不良事件发生率低于大多数其他解痉挛药。结论:西梅,drotaverine,和针灸在改善腹痛方面都优于安慰剂。在缓解全球IBS症状方面,针灸优于匹维胺,和针灸的不良事件比大多数抗痉挛药更低。
Background: Acupuncture has been extensively applied to manage irritable bowel syndrome (IBS) in clinical practice in China. Some randomized controlled trials (RCTs) have demonstrated their efficacy, but it has rarely been compared with first-line
antispasmodics to verify their effectiveness. Therefore, we compare acupuncture with
antispasmodics in the treatment of IBS by using an adjusted indirect treatment comparison meta-analysis. Methods: Embase, OVID Medline, and the Cochrane Central Register of Controlled Trials databases were searched from inception to 14 March 2022, with no language restrictions. RCTs comparing
antispasmodics or acupuncture with placebo or one of the
antispasmodics were enrolled. The primary outcome of interest was the improvement of abdominal pain. And the secondary outcomes of interest were the relief of global IBS symptoms and adverse events. The random-effects model was utilized to pool data. The effect size was measured by standardized mean difference (SMD) or relative ratio, and the effectiveness of acupuncture and different antispasmodics were ranked by P-scores. Results: Thirty-five RCTs (n = 5,190) were included. The analysis showed that cimetropium, drotaverine, acupuncture, and pinarverium were superior over placebo in relieving abdominal pain; cimetropium (SMD, -3.00 [95%CI, -4.47 to -1.53], P-score = 0.99) ranked the most effective. In pairwise comparisons, acupuncture had a greater improvement than most
antispasmodics except cimetropium and drotaverine in relieving abdominal pain, although the between-group difference was statistically insignificant. In the analysis of continuous outcome in the relief of global IBS symptoms, the result showed that pinaverium was more effective (SMD, 1.72 [95%CI, 0.53 to 2.92], P-score = 0.90) than placebo. Trimebutine and acupuncture had greater improvements than placebo, but no significant difference was shown between groups. In pairwise comparisons, acupuncture was more effective than pinaverium (SMD, -1.11 [95%CI, -1.94 to -0.28]) in relieving global IBS symptoms. In the analysis of adverse events, acupuncture had a lower adverse event rate than most of the other
antispasmodics. Conclusion: Cimetropium, drotaverine, and acupuncture were all better than placebo in improving abdominal pain. Acupuncture was preferred over pinaverium in relieving global IBS symptoms, and acupuncture had lower adverse events than most antispasmodics.