针灸治疗压力性尿失禁的有效性和安全性：一项系统综述和荟萃分析

IF 1.9 4区医学 Q3 INTEGRATIVE & COMPLEMENTARY MEDICINE

European Journal of Integrative Medicine Pub Date : 2025-01-01 DOI:10.1016/j.eujim.2024.102417

Jiakun Zhang , Zhongtong Ma , Jintong Shi , Wenjuan Shen , Jiali Wei , Mei Han

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引用次数: 0

摘要

压力性尿失禁（stress urinary incontinence， SUI）是由于体力消耗、打喷嚏或咳嗽引起的非自愿尿失禁。针灸作为一种世界公认的传统和补充医学，在中国被广泛用于治疗SUI。本综述旨在评价针刺治疗SUI女性的有效性和安全性。方法本系统评价（SR）由国家中医药管理局资助，注册号为PROSPERO （CRD42022361059）。数据库包括中国国家知识基础设施、万方数据库、中国科学期刊数据库、中国医学信息网、科学网、PubMed、Cochrane图书馆和Embase，检索了从数据库建立到2023年10月的相关随机对照试验（RCTs），这些试验涉及针灸治疗伴/不伴盆底肌肉训练（PFMT）。研究筛选和数据提取由两位作者独立进行。采用Cochrane’s risk of bias （RoB）工具2.0评价方法学质量。meta分析采用RevMan 5.3.5软件。结果本研究共纳入31项随机对照试验，共2885例患者。结果显示，针刺联合PFMT在减少SUI女性尿漏（RR = -1.87, 95% CI[-2.24, -1.49]， 13项研究，956例患者）和尿失禁问卷简表（ICI-Q-SF）评分（RR = -2.26, 95% CI[-2.64, -1.88]， 14项研究，1015例患者）方面的效果优于单纯PFMT。与假针相比，针刺改善了尿漏（RR = -4.22, 95% CI[-5.52, -2.93]， 5项研究，286例患者），CI- q - sf评分与MD的95% CI分别为-3.88(-4.59,-3.17),-8.71（-10.85,-6.57）和-3.10（-3.38,-2.82）。手针或电针的亚组分析和PFMT治疗的持续时间可以适当地减少异质性。对于1 h尿垫泄漏和ICI-Q-SF评分的Egger检验，提示该SR存在较小的发表偏倚可能性（p = 0.1257和p = 0.8058）。针刺组12例，假药组9例。（相对危险度= 1.33,95% CI = [0.56, 3.15], P = 0.70）。纳入本综述的随机对照试验的质量普遍较差。结论针刺治疗女性SUI有一定的治疗潜力，未见明显不良事件的报道。然而，考虑到纳入研究的方法学质量问题，本综述结论的可靠性可能会受到一定程度的影响。

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Effectiveness and safety of acupuncture for the treatment of stress urinary incontinence: A systematic review and meta-analysis

Introduction

Stress urinary incontinence (SUI) is an involuntary loss of urine on physical exertion, sneezing, or coughing. Acupuncture, a worldwide accepted traditional and complementary medicine, has been widely used in China to treat SUI. This review aims to evaluate the effectiveness and safety of acupuncture for women with SUI.

Methods

The protocol was registered in PROSPERO (CRD42022361059) and this systematic review (SR) was funded by the National Administration of Traditional Chinese Medicine. Databases including China National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database, SinoMed, Web of Science, PubMed, The Cochrane Library, and Embase were searched from their inception to October 2023, for relevant randomised controlled trials (RCTs) on the treatment of acupuncture with/without pelvic floor muscle training (PFMT). Study screening and data extraction were carried out independently by two authors. Methodological quality was evaluated using the Cochrane's risk of bias (RoB) tool 2.0. Meta-analysis was performed by RevMan 5.3.5.

Results

A total of 31 RCTs with 2885 patients were included in this SR. The results showed that the combination of acupuncture with PFMT had a better effect than PFMT only in decreasing urine leakage (RR = -1.87, 95 % CI [-2.24, -1.49], 13 studies, 956 patients) and Incontinence Questionnaire Short Form (ICI-Q-SF) scores (RR = -2.26, 95 % CI [-2.64, -1.88], 14 studies, 1015 patients) in women with SUI. Acupuncture compared with sham acupuncture demonstrated improvements in urinary leakage (RR = -4.22, 95 % CI [-5.52, -2.93], 5 studies, 286 patients), and ICI-Q-SF scores with MD and 95 % CI of -3.88(-4.59, -3.17), -8.71(-10.85, -6.57), and -3.10(-3.38, -2.82), respectively. Subgroup analyses of manual acupuncture or electroacupuncture and duration of PFMT treatment can appropriately reduce heterogeneity. For the Egger's test of 1-h pad leakage and of ICI-Q-SF scores, suggesting that there was a small possibility of publication bias in this SR (p = 0.1257 and p = 0.8058, respectively). Adverse events appeared in 12 participants in the acupuncture group and 9 in the sham group.(relative risk = 1.33, 95 % CI = [0.56, 3.15], P = 0.70). The quality of RCTs included in this review was generally poor.

Conclusion

Acupuncture has potential in the treatment of SUI in women, and no significant adverse events were reported. However, considering issues with the methodological quality of the included studies, the reliability of this review conclusion may be affected to a certain extent.

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来源期刊

European Journal of Integrative Medicine INTEGRATIVE & COMPLEMENTARY MEDICINE-

CiteScore

4.70

自引率

4.00%

发文量

102

审稿时长

33 days

期刊介绍： The European Journal of Integrative Medicine (EuJIM) considers manuscripts from a wide range of complementary and integrative health care disciplines, with a particular focus on whole systems approaches, public health, self management and traditional medical systems. The journal strives to connect conventional medicine and evidence based complementary medicine. We encourage submissions reporting research with relevance for integrative clinical practice and interprofessional education. EuJIM aims to be of interest to both conventional and integrative audiences, including healthcare practitioners, researchers, health care organisations, educationalists, and all those who seek objective and critical information on integrative medicine. To achieve this aim EuJIM provides an innovative international and interdisciplinary platform linking researchers and clinicians. The journal focuses primarily on original research articles including systematic reviews, randomized controlled trials, other clinical studies, qualitative, observational and epidemiological studies. In addition we welcome short reviews, opinion articles and contributions relating to health services and policy, health economics and psychology.