【Cochrane简语概要】针灸治疗成人膀胱过度活动症

系统综述问题

针灸是治疗成人膀胱过度活动症安全有效的疗法吗？

（图片来自boucheclinic.org）

研究背景

膀胱过度活动症这个术语用于描述一系列泌尿症状，包括急切排尿需求、频繁排尿、尿失禁以及夜晚醒来一次或多次去排尿（夜尿）。患者可能有一种或多种上述症状。膀胱过度活动症是一种常见病，会影响各年龄段的男性和女性，尽管它在老年人中更常见。治疗方法包括膀胱训练、盆底肌锻炼、药物治疗、向膀胱壁注射肉毒杆菌、骶骨神经调节以及手术疗法。

针灸是指将细针扎入身体特定穴位用以强身健体的疗法。针灸被用于治疗多种疾病，并被建议作为一种可能的治疗方式用于膀胱过度活动症。

本综述时效性如何？

本综述纳入了截至2022年5月14日发表的所有符合我们纳入标准的研究。我们知晓有6项研究正在进行，2项研究无法获取全部资料，本综述没有纳入这些研究。

研究特征

我们纳入了15项研究、涉及总共1395名膀胱过度活动症受试者。大多数研究受试者数量较少，我们对大多数研究的研究设计和/或研究进程持保留意见。

研究资金来源

纳入的15项研究中，4项由中国政府提供研究资金，2项由高等教育机构赞助。一项研究的开放存取出版费用由挪威针灸协会支付。八项研究没有报告资金来源。

主要结果

这些研究使用不同的方法，使研究结果难以进行比较。

与不治疗相比，针灸治疗或改善膀胱过度活动症症状和次要副作用数量的疗效非常不确定。没有发生重大不良事件。没有报告涉及与不治疗相比，针灸对减少尿急、日间尿频、尿失禁发作或夜尿症发作方面的疗效。

与假针灸相比，针灸治疗或改善膀胱过度活动症症状的疗效不确定。与假针灸相比，针灸对次要不良事件数量的影响很小或没有影响。所有研究没有发生重大不良事件。针灸治疗尿急、日间尿频或夜尿症发作方面的疗效，证据非常不确定。针灸与假针灸在治疗尿失禁发作方面很可能没有差异。

与药物治疗相比，针灸也许可以略微改善膀胱过度活动症症状、减少次要不良事件数量。没有发生重大不良事件。与药物治疗相比，针灸治疗尿急和尿失禁发作的疗效非常不确定。与药物治疗相比，针灸治疗尿频的疗效可能相同，减少夜尿次数的疗效略好。

证据质量

本综述大多数证据的质量极低或低，这是由于纳入的研究在设计和/或执行中存在缺陷。许多研究的受试者数量很少，且研究持续时间短。考虑到这些问题，很难对针灸治疗膀胱过度活动症的疗效做出定论。需要后续设计完善的大规模研究来回答这个问题。

作者结论: 

证据非常不确定，无法判断与不治疗相比，针灸治疗或改善膀胱过度活动症症状的疗效。不确定针灸与假针灸在治疗或改善膀胱过度活动症症状方面是否存在差异。本综述提供低质量证据表明，与药物治疗相比，针灸可能在治疗或改善膀胱过度活动症症状方面疗效略好，且可能减少次要不良事件的发生率。

在完成相关的，可比较结局指标的更大型高质量研究之前，这些只是暂定的结论。治疗的时间和频率、穴位选择、应用和长期随访都是与研究相关的其他领域。

作者:Hargreaves E, Baker K, Barry G, Harding C, Zhang Y, Kandala N-B, Zhang X, Kernohan A, Clarkson CE；译者：何帆，武汉大学；审校：靳英辉，武汉大学中南医院循证与转化医学中心；编辑排版：索于思，北京中医药大学循证医学中心

相关文章链接

【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.

Authors' conclusions: 

The evidence is very uncertain about the effect acupuncture has on cure or improvement of overactive bladder symptoms compared to no treatment. It is uncertain if there is any difference between acupuncture and sham acupuncture in cure or improvement of overactive bladder symptoms. This review provides low-certainty evidence that acupuncture may result in a slight increase in cure or improvement of overactive bladder symptoms when compared with medication and may reduce the incidence of minor adverse events.

These conclusions must remain tentative until the completion of larger, higher‐quality studies that use relevant, comparable outcomes. Timing and frequency of treatment, point selection, application and long-term follow-up are other areas relevant for research.

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