Objective: A network Meta-analysis based on Bayesian theory was used to evaluate efficacy and safety of acupuncture and moxibustion in the treatment of dry eye disease(DED), so as to provide evidence-based research basis for clinical application.
Methods: Randomized controlled trials (RCT) for acupuncture and moxibustion treatment of DED published from the inception of database to November 25, 2020 were searched from PubMed, Embase, Cochrane Library, Web of Science, Sinomed, CNKI, Wanfang and VIP Database. Two reviewers independently screened the literatures, extracted the data. The quality of the included literature was evaluated, and network Meta-analysis was performed by using Stata14.0 and R4.0.3 software.
Results: A total of 71 literatures were identified, including 5 536 patients with DED, covering 11 different interventions. Network Meta-analysis showed that acupuncture+traditional Chinese medicine+artificial tears was the best treatment option in terms of the clinical effective rate, breakup time of tear film (BUT), Schirmer I test (SIT) with surface under cumulative ranking area value. Acupuncture+traditional Chinese medicine+artificial tears was better than artificial tears in the clinical effective rate (odds ratio［OR］=12.34, 95% confidence interval［CI］［4.72, 36.89］), BUT(mean differenc［MD］=2.76, 95%CI［0.16, 5.40］), SIT(MD=4.76, 95%CI［1.23, 8.29］).
Conclusion: Acupuncture and moxibustion in the treatment of DED are generally better than artificial tears, and acupuncture-moxibustion combined with other traditional Chinese medicine therapy has the best effect.
目的：采用基于贝叶斯原理的网状Meta分析方法，评价针灸治疗干眼的有效性及安全性，为后续的临床应用提供循证依据。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、中国知网、万方和维普数据库，搜集针灸及其联合疗法治疗干眼的随机对照临床试验文献，检索时限为建库至2020年11月25日。由2位评价员独立筛选文献、提取资料并对纳入的研究进行风险偏倚评估，采用Stata14.0和R4.0.3软件进行数据分析并绘制相关图形。结果：本研究共纳入71篇文献，涉及干眼患者5 536例，涵盖11种不同干预措施。网状Meta分析结果显示，在治疗总有效率、泪膜破裂时间(BUT)、泪液分泌试验(SIT)方面，累积排序概率图下面积值最优的干预措施是针刺+中药+人工泪液三联疗法(0.94),其总有效率(OR=12.34, 95%CI［4.72, 36.89］)、BUT(MD=2.76, 95%CI［0.16, 5.40］)、SIT(MD=4.76, 95%CI［1.23, 8.29］)，均显著优于人工泪液类药物。结论：各类针灸疗法在治疗干眼方面均普遍优于人工泪液，其中针灸综合疗法疗效最佳。建议结合中医辨证及临床实际情况合理选择。.
Keywords: Acupuncture and moxibustion; Artificial tears; Dry eye disease; Network Meta-analysis.