陈茜 周愉 董艳娇 张孟

摘要  目的：運用Meta分析评价针刺调神法治疗腹泻型肠易激综合征（IBS-D）的疗效。方法：计算机检索各类数据库中关于针刺调神治疗IBS-D的临床随机对照试验文献;纳入研究符合罗马III诊断标准;文献质量运用Revman5.3软件中Cochrane手册风险偏倚工具评估，纳入研究的数据应用RevMan 5.3软件分析;以上均由2名评价员独立完成。结果：1）纳入10篇研究，总察病例533例，针刺调神组284例，其他方法组249例。2）Meta分析结果显示：针刺调神法治疗IBS-D临床疗效优于其他治疗方法， P <0.000 01，差异有统计学意义（OR=4.09，95%CI：2.41-6.93）;针刺调神组IBS-SSS评分优于西药组，差异有统计学意义;针刺调神法与其他方法在改善HAMD方面由于异质性过大、样本量小，未体现出明显差异性;3）纳入研究漏斗图提示可能有潜在的发表偏倚。4）纳入研究未明确报道随访。结论：1）针刺调神法治疗IBS-D的有效性优于西药与常规针刺，可明显改善IBS-SSS评分，改善临床症状;该法具有改善焦虑、抑郁等情志问题的潜质，应进行大样本、高质量临床对照研究，以进一步提高的循证医学证据。2）应拓宽调神法的运用思路，“脑肠同治”，丰富针刺调神法治疗IBS-D的方案。

关键词  腹泻型肠易激综合征;针刺调神法;随机对照试验;Meta分析

A Meta-Analysis on the Method of Acupuncture Spirit-Regulation for Treating Irritable Bowel Syndrome with Diarrhea

CHEN Qian1，ZHOU Yu2，DONG Yanjiao1，ZHANG Meng1，Director：GONG Yi3，XIE Jun3

（1 Yunnan University of Traditional Chinese Medicine，Kunming 650000，China; 2 Wenshan State Hospital of Traditional Chinese Medicine，Wenshan 663099，China; 3 Yunnan Province Hospital of Traditional Chinese Medicine/First Affliated Hospital of Yunnan Province Hospital of Traditional Chinese Medicine，Kuming 650000，China）

Abstract Objective： Meta-analysis was applied to evaluate the effectiveness of acupuncture method of spirit-regulation in the treatment of irritable bowel syndrome with diarrhea（IBS-D）. Methods： Various databases about clinical randomized controlled trials（RCT）of acupuncture method of spirit-regulation in the treatment of IBS-D was retrieved by computer; the included study met the Rome III diagnostic criteria; literature quality was assessed by the Cochrane risk bias tool in Revman5.3 software，and the data included in the study were analyzed by RevMan 5.3 software; all the above were completed by 2 evaluators independently. Results： 1）A total of 10 literature were included，with 533 total cases.Among them，284 were in acupuncture method of spirit-regulation group and 249 patients were in the other groups.2）Results of Meta analysis showed that：the clinical efficacy of the acupuncture method of spirit-regulation group was better than that of the other group，and difference was statistically significant， P <0.00001（OR=4.09，95%CI：2.41-6.93）; IBS-SSS score of acupuncture method of spirit-regulation group were better than that of the Western medicine group，and difference was statistically significant.Acupuncture method of spirit-regulation and other methods did not show obvious differences in improving HAMD due to excessive heterogeneity and small sample size.3）The inclusion of symmetrical funnel plots suggests that the risk of potential publication bias was small. Conclusion： 1）Acupuncture method of spirit-regulation is more effective in treating IBS-D than Western medicine and conventional acupuncture and can significantly improve IBS-SSS score and clinical symptoms.This method has the potential to improve emotional problems such as anxiety and depression，and a large sample of high-quality controlled clinical studies should be conducted to further improve the evidence of evidence-based medicine.2）It is necessary to broaden the application idea of spirit-regulating method，adopt “brain-gut treatment” and enrich the program of spirit-regulating method of acupuncture for the treatment of IBS-D.

Keywords  Irritable bowel syndrome with diarrhea（IBS-D）; Method of acupuncture spirit-regulation; Randomized controlled trials; Meta-Analysis

中图分类号：R245;R246 文献标识码：A  doi： 10.3969/j.issn.1673-7202.2020.14.012

肠易激综合征（Irritable Bowel Syndrome，IBS）为一种功能性胃肠病（FGIDs），病程长，病情复杂难控，伴随症多，可属心身性疾病;而主要症状的轻重可随着情绪、睡眠等其他因素的变化的变化，可属心身性疾病的心身症状[1]。现代医学对IBS病因病理、临床症状等的认知方面，重视神经胃肠病学和脑-肠互动多方面异常，并称FGIDs为脑-肠互动异常[2]。腹泻型肠易激综合征（IBS-D）为IBS一个亚型，主要表现不正常的排便为腹泻，反复发作的腹痛与排便相关。相关流行病调查显示我国的患病率呈上升趋势，男性低于女性，亚型腹泻型（IBS-D）较多见，且发现IBS-D患者的生命质量低于便秘型（IBS-C）患者，经济负担较重[3-4]。西药的治疗主要针对肠动力、高敏感、黏膜免疫、炎性反应、微生态环境等方面进行特异性症状的控制。 中医对疾病的认知具有整体全面性。Meta分析显示，针刺治疗腹泻型肠易激综合征在改善IBS-D患者临床症状和降低复发率上疗效优于常规西药[5]。……