世界中医药

目的:分析针灸相关的Cochrane系统评价来评估针灸的临床疗效和安全性。方法:以John Wiley&Sons公司2018年第5期“The Cochrane Library”（网络版）为数据基础，关键词为acupuncture or acupoint or acupressure or electroacupuncture or moxibustion进行全文搜索，纳入与针灸相关，包括手针、电针、穴位按压、经皮电刺激、艾灸等更新至最新版本的系统评价全文。结果:最终纳入81篇与针灸相关的Cochrane系统评价，发表量呈现出波动上升的趋势，2009年以后增长较快。发表前5名的国家依次是中国（23篇，占28.4%）、英国（17篇，占21.0%）、澳大利亚（15篇，占18.5%）、加拿大（6篇，占7.4%）、美国（4篇，占4.9%）。涉及了30个Cochrane协作组，研究较多的领域为神经系统疾病（21篇）、泌尿生殖系统疾病（10篇）、妊娠分娩和产褥期疾病（11篇）、肌肉骨骼系统和结缔组织的疾病（9篇）、精神和行为障碍疾病（5篇）。其中21篇（25.9%）认为针灸相关治疗有效，5篇（6.2%）不支持针灸相关治疗，55篇（67.9%）为当前证据不足以判断针灸的临床疗效。结论:针灸被广泛应用于各类疾病，拓宽了针灸疾病谱，进一步分析发现，针灸尤善治疗疼痛相关疾病。然而由于RCT研究设计的方法学缺陷以及报道质量低，导致大部分CRS都提示研究证据级别低。

English Summary:

To evaluate the clinical efficacy and safety of acupuncture and moxibustion by analyzing Cochrane system review. Methods:Based on the data from the fifth “The Cochrane Library” in 2018, the keywords “acupuncture or acupoint or acupressure or electroacupuncture or moxibustion” were adopted to search the relevant full articles of systems review regarding acupuncture, such as manual acupuncture, electroacupuncture, acupressure, transcutaneous electrical stimulation and moxibustion. Results:Finally, 81 acupuncture Cochrane systematic reviews were included and the publications of those showed an upward trend, especially increased rapidly after 2009. The amount of publication in top five country was China (23, 28.4%), Britain (17, 21%), Australia (15, 18.5%), Canada (6, 7.4%), and the United States (4, 4.9%), involving 30 Cochrane collaborate groups, in which the core field of research were neurological diseases (21), genitourinary system diseases (10), pregnancy delivery and puerperal diseases (11), musculoskeletal system and connective tissue diseases (9), mental and behavioral disorders (5). Among included studies, 21 of them (25.9%) believed that acupuncture showed treatment effects, and 5 of them (6.2%) did not acknowledge the therapeutic effect of acupuncture, 55 of them (67.9%) did not provide sufficient evidence to prove the clinical efficacy of acupuncture. Conclusion:Acupuncture is widely used in various diseases, which broadens the spectrum of acupuncture and moxibustion. In addition, further analysis indicated that acupuncture shows especially positive treatment for pain diseases. However, most of CRS indicated low level of research evidence due to the methodological flaws of RCT study design and poor reporting quality.

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