鑽石舞台

系統綜述問題

針灸是治療成人膀胱過度活動症安全有效的療法嗎？

（圖片來自boucheclinic.org）

研究背景

膀胱過度活動症這個術語用於描述一系列泌尿症狀，包括急切排尿需求、頻繁排尿、尿失禁以及夜晚醒來一次或多次去排尿（夜尿）。患者可能有一種或多種上述症狀。膀胱過度活動症是一種常見病，會影響各年齡段的男性和女性，儘管它在老年人中更常見。治療方法包括膀胱訓練、盆底肌鍛煉、藥物治療、向膀胱壁注射肉毒桿菌、骶骨神經調節以及手術療法。

針灸是指將細針扎入身體特定穴位用以強身健體的療法。針灸被用於治療多種疾病，並被建議作為一種可能的治療方式用於膀胱過度活動症。

本綜述時效性如何？

本綜述納入了截至2022年5月14日發表的所有符合我們納入標準的研究。我們知曉有6項研究正在進行，2項研究無法獲取全部資料，本綜述沒有納入這些研究。

研究特徵

我們納入了15項研究、涉及總共1395名膀胱過度活動症受試者。大多數研究受試者數量較少，我們對大多數研究的研究設計和/或研究進程持保留意見。

研究資金來源

納入的15項研究中，4項由中國政府提供研究資金，2項由高等教育機構贊助。一項研究的開放存取出版費用由挪威針灸協會支付。八項研究沒有報告資金來源。

主要結果

這些研究使用不同的方法，使研究結果難以進行比較。

與不治療相比，針灸治療或改善膀胱過度活動症症狀和次要副作用數量的療效非常不確定。沒有發生重大不良事件。沒有報告涉及與不治療相比，針灸對減少尿急、日間尿頻、尿失禁發作或夜尿症發作方面的療效。

與假針灸相比，針灸治療或改善膀胱過度活動症症狀的療效不確定。與假針灸相比，針灸對次要不良事件數量的影響很小或沒有影響。所有研究沒有發生重大不良事件。針灸治療尿急、日間尿頻或夜尿症發作方面的療效，證據非常不確定。針灸與假針灸在治療尿失禁發作方面很可能沒有差異。

與藥物治療相比，針灸也許可以略微改善膀胱過度活動症症狀、減少次要不良事件數量。沒有發生重大不良事件。與藥物治療相比，針灸治療尿急和尿失禁發作的療效非常不確定。與藥物治療相比，針灸治療尿頻的療效可能相同，減少夜尿次數的療效略好。

證據質量

本綜述大多數證據的質量極低或低，這是由於納入的研究在設計和/或執行中存在缺陷。許多研究的受試者數量很少，且研究持續時間短。考慮到這些問題，很難對針灸治療膀胱過度活動症的療效做出定論。需要後續設計完善的大規模研究來回答這個問題。

作者:Hargreaves E, Baker K, Barry G, Harding C, Zhang Y, Kandala N-B, Zhang X, Kernohan A, Clarkson CE；譯者：何帆，武漢大學；審校：靳英輝，武漢大學中南醫院循證與轉化醫學中心；編輯排版：索于思，北京中醫藥大學循證醫學中心

相關文章鏈接

【Cochrane簡語概要】針灸治療慢性非特異性腰痛

【Cochrane Plain Language Summary】

Acupuncture for treating overactive bladder in adults

Review question

Is acupuncture a safe and effective treatment for treating overactive bladder in adults?

Background

Overactive bladder is the term used to describe a group of urinary symptoms, including an urgent need to pass urine, frequent voiding (emptying), urinary incontinence and waking one or more times at night to pass urine (nocturia). Sufferers may have one or more of these symptoms. Overactive bladder is a common complaint and can affect both men and women of any age, though it is more common in older people. Treatment can include bladder education, pelvic floor exercises, medication, botox injections into the bladder wall, sacral neuromodulation and surgery.

Acupuncture refers to the practice of inserting fine needles into defined points on the body in order to achieve an improvement in health. It is used in a wide range of conditions and has been suggested as a possible treatment for overactive bladder symptoms.

How up-to-date is this review?

This review includes all studies that met our eligibility criteria, published up to 14 May 2022. We are aware of six ongoing studies and two studies that we cannot obtain in full, which were not included in our review.

Study characteristics

We included 15 studies involving a total of 1395 participants with overactive bladder. The majority of the studies had small numbers of participants and we had some reservations about the study designs, processes or both in the majority of the studies.

Study funding sources

Of the 15 included studies, four were supported by Chinese Government-funded research grants and two were funded by Higher Education institutions. The open access publishing fee for one study was paid by the Norwegian Acupuncture Association. Eight studies did not report any source of funding.

Key results

The different methods used by the studies made the comparison of results difficult.

Compared to no treatment, the effect of acupuncture on curing or improving overactive bladder symptoms and the amount of minor side effects is very uncertain. No major adverse events took place. The were no reports on the effect of acupuncture compared to no treatment with regard to reducing urinary urgency, daytime urinary frequency, episodes of urinary incontinence or episodes of nocturia.

Compared to sham (fake) acupuncture, the effect of acupuncture on curing or improving overactive bladder symptoms is uncertain. Acupuncture probably makes little or no difference to the number of minor adverse events compared to sham acupuncture. No major adverse events took place in any of the studies. The evidence is very uncertain regarding the effect of acupuncture on the presence of absence of urinary urgency, daytime urinary frequency or episodes of nocturia. There is probably no difference between acupuncture and sham acupuncture in terms of episodes of urinary incontinence.

Acupuncture may result in a slight improvement in overactive bladder symptoms when compared with medication and may result in a reduced number of minor adverse events. No major adverse events took place. The effect of acupuncture compared to medication is very uncertain with regard to urinary urgency and episodes of incontinence. Acupuncture may have the same effect as medication on urinary frequency and may slightly reduce episodes of nocturia.

Certainty of the evidence

The majority of the evidence in this review is of very low or low certainty because the included studies had flaws in their design and/or execution. Many had small numbers of participants and were conducted over a short period of time. Given these issues, it is difficult to draw conclusions regarding how effective acupuncture is for treating overactive bladder. Further well-designed, large-scale studies are required to answer this question.