Page 120 - 2022-26-中国全科医学

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certain adverse reactions and complications. However，the clinical application of filiform acupuncture in the treatment of BPH
has a significant effect，but there is a lack of evidence-based evidence. Objective To systematically review the clinical efficacy
of acupuncture therapy in treating BPH. Methods The randomized controlled trials（RCTs） on acupuncture for BPH were
retrieved from CNKI，VIP，Wanfang Data，SinoMed，PubMed and Cochrane Library by computer from inception to October1，
2021，including the experimental group treated by acupuncture，with or without the drugs used in the control group and the
control group treated by conventional western medicine. According to inclusion and exclusion criteria，the literature was extracted
and evaluated by using RevMan 5.3 software. Results A total of 17 articles and 1 547 patients were included. Meta-analysis
results showed that the clinical effective rate and maximum urinary flow rate（Qmax） of the experimental group were higher than
those of the control group〔OR=3.21，95%CI（2.25，4.57），P<0.000 01；MD=2.48，95%CI（1.26，3.70），P<0.000 1〕.
The international prostate symptom score（IPSS），residual urine volume（PVR），prostate volume（PV），and quality of
life（QOL） score in the experimental group were lower than those in the control group〔MD=-2.39，95%CI（-3.84，-0.94），
P=0.001；MD=-10.59，95%CI（-15.20，-5.98），P<0.000 01；MD=-3.50，95%CI（-5.07，-1.93），P<0.000 1；
MD=-0.68，95%CI（-0.99，-0.37），P<0.000 1〕. The clinical effective rate and Qmax of acupuncture alone in treating BPH
were higher than those of western medicine〔OR=3.53，95%CI（2.20，5.68），P<0.000 01；MD=2.75，95%CI（1.62，3.88），
P<0.000 01〕. The PVR，PV and QOL of acupuncture alone in treating BPH were lower than those of western medicine〔MD=-9.41，
95%CI（-15.87，-2.94），P=0.004；MD=-2.99，95%CI（-4.86，-1.12），P=0.002；MD=-0.74，95%CI（-1.33，-0.15），
P=0.01〕. The clinical effective rate of acupuncture+western medicine for BPH was higher than that of western medicine〔OR=2.84，
95%CI（1.67，4.82），P=0.000 1〕；IPSS，PVR，PV and QOL of acupuncture+western medicine for BPH were lower than
that of western medicine〔MD=-2.88，95%CI（-3.43，-2.32），P<0.000 01；MD=-12.25，95%CI（-16.92，-7.57），
P<0.000 01；MD=-4.41，95%CI（-8.03，-0.79），P=0.02；MD=-0.59，95%CI（-1.03，-0.15），P=0.008〕. There
were no obvious adverse reactions in both groups. The sensitivity analysis of IPSS，Qmax，PVR，PV and QOL results showed
that the change effect model had no significant effect on the combined results. Funnel plot analysis was performed on RCTs of
clinical response rate，IPSS，Qmax，PVR，and QOL，and the results showed that the funnel diagram of clinical response
rate was basically symmetrical on both sides. The funnel plots of IPSS，Qmax，PVR，and QOL were scattered，and there was
publication bias. Conclusion Based on the current clinical evidence，the clinical efficacy and Qmax of acupuncture therapy for
BPH were higher than those of the control group，and the IPSS，PVR，PV，and QOL were lower than those of the control group.
Since funnel plots of IPSS，Qmax，PVR and QOL are scattered and have publication bias，the results of this study need further
verification.
【Key words】 Prostatic hyperplasia；Acupuncture；Traditional Chinese medicine therapy；Treatment outcome；
Meta-analysis

良性前列腺增生（benign prostatic hyperplasia，BPH）是 法治疗 BPH 的临床疗效，以期为临床应用提供循证医学证据。
指随着年龄的增长，男性前列腺腺体及肌肉组织出现过分增 1 资料与方法
［1］
殖 ，继而表现出一系列刺激性症状（如尿频、尿急、尿失禁等） 1.1 文献检索策略 由 2 位研究人员分别独立检索中国知
［2］
及梗阻性症状（如尿线变细、尿踌躇、排尿不净、尿滴沥等） 。 网、维普网、万方数据知识服务平台、中国生物医学文献服
据统计，50 岁以上男性人群发病率接近 40%，70 岁以上发病 务系统、PubMed、Cochrane Library 数据库，搜集关于针刺
率高达 70%~80%，其中又以城镇居民为主，占 46.79% ［3］ 。 疗法治疗 BPH 的随机对照试验（RCT），检索时间为建库
现代医学对于 BPH 发病机制的阐述尚不完全清楚，普遍认为 至 2021-10-01。手工检索《中华男科学杂志》《中华泌尿
年龄因素和性腺功能水平是 BPH 发病的主要内因，同时也与 外科杂志》《中国性科学》《中国男科学杂志》《临床泌尿
雌、雄激素比例及肥胖、生活方式、前列腺炎等相关 ［4］ 。因此， 外科杂志》《国际泌尿系统杂志》《现代泌尿外科杂志》
改善 BPH 症状刻不容缓。目前临床上多采用微创介入、手术 泌尿外科和男科相关杂志。检索词为主题词 + 自由词方式
切除或使用 α- 受体阻滞剂等药物治疗 BPH，药物治疗虽为 进行，中文检索词包括：“针刺”“电针”“体针”“毫
一线疗法但无法解决病因及危险因素的问题，而微创外科手 针”“头针”“穴”“针灸”和“良性前列腺增生”“前列
术治疗易出现并发症，导致患者接受度不高，其普及程度和 腺增生”“前列腺肥大”“随机对照试验”等；英文检索词
推广度也受到一定限制 ［5］ 。针刺疗法可刺激支配前列腺的神 包 括：“acupuncture”“electro-acupuncture”“needling”
经、经络，缓解 BPH 的症状，缩小增生的前列腺体积，调整 “earacupuncture”“acupuncturetherapy”“benign prostatic
膀胱功能 ［6］ 。目前已有较多应用针刺疗法治疗 BPH 的临床试 hyperplasia”“prostatichyperplasia”“randomized”
验，但目前此方面研究多呈散在性，采用科学方法进行 Meta “clinicaltrial”“controlled trial”。
分析的研究发表较少，本研究通过 Meta 分析旨在评价针刺疗 1.2 文献纳入与排除标准