目的：评价针刺治疗带状疱疹的有效性和安全性,为带状疱疹患者的循证治疗提供可靠证据。方法：计算机检索PubMed、Cochrane Library、CNKI、万方等数据库,并辅以手工检索获得相关随机对照试验(RCT)的相关文献,检索时限均从建库至2019年4月。采用RevMan 5.3 软件进行Meta分析,客观评价其临床疗效。结果：共纳入17个RCT,1434例患者。对这17个研究行Meta分析,结果显示：(1)与西医常规治疗组相比,针刺治疗组的综合疗效较好,且治疗后的后遗神经痛发生率低［RR=0.30,95%CI(0.18,0.50),P＜0.00001；RR=0.16,95%CI(0.09,0.29),P＜0.0001］,患者疼痛持续时间、疱疹止疱时间、结痂时间、脱痂时间以及患者疼痛感觉程度均明显缩小［MD= -11.53,95%CI(–813.52,–9.54),P＜0.00001；MD= -1.53,95%CI(–1.67,–1.40),P＜0.00001；MD= -3.12,95%CI(–3.48,–2.76),P＜0.00001；MD= -3.12,95%CI(–3.48,–2.76),P＜0.00001；MD=-2.50,95%CI(-2.80,-2.19),P＜0.0001］；(2)不同针刺方法治疗带状疱疹患者各项指标改善情况Meta分析结果显示：①电针、火针治疗与西药常规治疗相比,电针、火针治疗比西药常规治疗效果好［RR=0.41,95%CI(0.21,0.81),P=0.01；RR=0.16,95%CI(0.06,0.45),P=0.0004］②普通针刺治疗与西药常规治疗相比,治疗后患者疼痛感觉强度明显降低［MD=-2.40,95%CI(-2.71,-2.10), P＜0.00001］(3)针刺治疗组仅有1例轻度心慌,1例轻度头昏,均不影响实验结果。结论：针刺干预后患者综合症状改善情况、疱疹止疱时间、结痂时间、脱痂时间、疼痛程度评分(VAS)、后遗神经痛发生情况较对照组均有明显改善,且临床安全性高。
Objective To evaluate the efficacy and safety of acupuncture treatment for herpes zoster and to provide reliable evidence for evidence-based treatment of herpes zoster. Methods PubMed, Cochrane Library, CNKI, Wanfang and other databases were searched by computer, and the related literatures about randomized controlled trial (RCT) were obtained by manual searching. The retrieval time limit was from the establishment of the database to April 2019. Meta analysis was performed with RevMan 5.3.The clinical efficacy was evaluated objectively. Results A total of 17 patients with RCT, 1434 were included, and Meta analysis was performed on these 17 studies. Fristly, compared with the routine western medicine treatment group, the comprehensive curative effect of the acupuncture treatment group was better than that of the routine western medicine treatment group. The incidence of sequelae neuralgia after treatment was low [RR= 0.30, 95%CI (0.18, 0.50), P < 0.0001; RR= 0.16, 95%CI (0.09, 0.29), P < 0.0001), pain duration, herpes blister arrest time, scab formation time, eschar removal time and pain sensation were significantly reduced [MD -11.53, 95%CI (-813.52, -9.54), P < 0.00001; MD -1.53, 95%CI (-1.67, -1.40), P < 0.0001; MD -3.12, 95%CI (-3.48, -2.76), P < 0.0001; MD -3.12, 95%CI (-3.48, -2.76), P < 0.0001); MD -2.50, 95%CI (-2.80, -2.19), P < 0.0001); Secondly, different acupuncture methods for banded treatment. The results of Meta-analysis of the improvement of various indexes in patients with herpes showed that compared with the routine treatment of western medicine, electroacupuncture and fire needle therapy. The effect of electroacupuncture and fire acupuncture was better than conventional western medicine [RR 0.41, 95%CI (0.21, 0.81), P ≥ 0.01; RR 0.16,95%CI (0.06, 0.45), P ≤ 0.0004]. And compared with routine western medicine treatment, the pain sensation intensity of the patients after treatment was significantly decreased [MD -2.40, 95%CI (- 2.71, -2.10), P < 0.00001]. Meanwhile, compared with conventional western medicine treatment, the pain sensation intensity of the patients after treatment was significantly lower than that of conventional western medicine treatment. Lastly, in acupuncture treatment group, there were only 1 case of mild panic and 1 case of mild dizziness. The experimental results were not affected. Conclusion: After acupuncture intervention, the comprehensive symptom improvement, herpes blister stop time, scab formation time, eschar removal time, pain degree score (VAS) and the occurrence of sequelae neuralgia were significantly improved compared with the control group, and the clinical safety was higher.