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Tuina treatment for children and adults with functional dyspepsia: a meta-analysis and systematic review of randomized controlled trials

推拿治疗儿童及成人功能性消化不良: 一项随机对照试验的Meta分析和系统综述

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Abstract

Objective

To evaluate the efficacy and safety of Tuina (Chinese therapeutic massage) in the treatment of functional dyspepsia (FD) in children and adults.

Methods

Related articles in PubMed, Excerpta Medica Database (EMBASE), Cochrane Library, Web of Science, China Biology Medicine Disc (CBM), Wanfang Academic Journal Full-text Database (Wanfang), China National Knowledge Infrastructure (CNKI), and Chongqing VIP Database (CQVIP) were collected. The retrieval time was from each database’s start to March 2022. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies. A meta-analysis was then performed using the RevMan 5.4 software.

Results

A total of 19 clinical trials were included, 9 of which encompassed studies on adults while 10 were on children with FD, comprising a total of 1 961 patients. The findings of the meta-analysis showed that the effective rate of FD in children and adults treated with Tuina was significantly higher than that in the control group [risk ratio (RR)=1.15, 95% confidence interval (CI) (1.09, 1.21), P<0.001], [RR=1.13, 95%CI (1.06, 1.21), P<0.001]. In addition, the effective rate of FD in children and adults treated with Tuina combined with other treatments was significantly higher than that in the control group [RR=1.14, 95%CI (1.07, 1.21), P<0.001], [RR=1.12, 95%CI (1.02, 1.24), P=0.02]. In terms of single symptoms, Tuina improved epigastric burning sensation score in adults [standardized mean difference (SMD)=-0.41; 95%CI (-0.79, -0.02); Z=2.08; P=0.04] compared with that of the Western medicine group. Compared with children treated with oral Chinese medications (CM) or Chinese patent medicine (CPM), children with FD demonstrated lower scores of epigastric pain [SMD=-0.38, 95%CI (-0.56, -0.19); Z=3.96; P<0.001], postprandial fullness [SMD=-0.30, 95%CI (-0.50, -0.10); Z=2.88; P=0.004], and early satiety [SMD=-0.26, 95%CI (-0.47, -0.06); Z=2.54; P=0.01] after receiving Tuina combined with CM or CPM treatment. No adverse events were reported in the Tuina treatment group, and the follow-up indicated that the symptom scores in the Tuina group improved.

Conclusion

Compared with the control group, both Tuina and Tuina combined with other treatments are shown to have better effective rates, lower incidence of adverse events, and better follow-up outcomes. The study results suggest that Tuina may be a clinically viable complementary therapy. However, due to limitations in the number and quality of the included studies, the above conclusions should be verified by further high-quality studies.

摘要

目的

评价推拿疗法治疗儿童和成人功能性消化不良(FD)的疗效和安全性.

方法

收集PubMed、 荷兰医学文摘(EMBASE)、 Cochrane Library、Web of Science、 中国生物医学文献数据库(CBM)、 万方学术期刊全文数据库(Wanfang)、 中国知网(CNKI)和重庆维普数据库(CQVIP)的相关文章. 检索时间截止到2022年3月. 两名研究人员独立筛选文献, 提取数据, 并评估偏倚风险. 使用RevMan 5.4软件进行meta分析.

结果

共纳入19项临床试验, 其中9项 为成人研究, 10项为儿童研究, 共纳入1 961例患者. 分析结果显示推拿治疗小儿和成人FD的有效率均显著高于对照组[风险比(RR)=1.15, 95%可信区间(CI) (1.09, 1.21), P<0.001], [RR=1.13, 95%CI (1.06,1.21), P<0.001]. 此外, 推拿联合其他疗法治疗小儿及成人FD的有效率均显著高于对照组[RR=1.14, 95%CI (1.07, 1.21), P<0.001], [RR=1.12, 95%CI (1.02, 1.24), P=0.02]. 与口服西药比较, 推拿可降低成人的上腹部烧灼感评分[标准均数差(SMD)=-0.41; 95%CI (-0.79, -0.02); Z=2.08; P=0.04]. 相较口服中药(CM)或中成药(CPM)治疗的FD患儿, 推拿联合CM或CPM治疗后, FD患儿胃脘痛评分降低[SMD=-0.38, 95%CI (-0.56, -0.19); Z=3.96; P<0.001], 餐后饱腹感不适[SMD=-0.30, 95%CI (-0.50, -0.10); Z=2.88; P=0.004], 早期饱腹症状[SMD=-0.26, 95%CI (-0.47, -0.06); Z=2.54; P=0.01]. 推拿治疗组无不良事件报告, 且随访显示推拿组症状评分得到改善.

结论

与对照组相比, 推拿治疗和推拿联合其他疗法均有更好的有效率、 更低的不良事件发生率和更好的随访结局. 对于成人, 与口服西药治疗相比, 推拿疗法可降低上腹部烧灼感评分. 对于FD患儿, 与单服CPM相比, 推拿联合CPM治疗可降低患儿上腹部疼痛、餐后饱胀不适感和早饱症状评分. 本研究结果提示推拿可能是一种临床可行的补充疗法. 但是由于所纳研究的数量和质量的限制, 上述结论需要更多高质量研究的补充验证.

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Data Availability

The data supporting this research article are available from the corresponding author upon reasonable request.

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Acknowledgments

This work was supported by the International (Regional) Cooperation and Exchange Project of National Natural Science Foundation of China [国家自然科学基金国际(地 区)合作与交流项目, No. 81820108033]. The registration number of this study in International Prospective Register of Systematic Reviews is CRD42022321222.

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Authors and Affiliations

  1. Wangjing Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100102, China

    Zijing Tao  (陶紫晶), Zeng Cao  (曹增), Qian Liu  (刘倩), Xiaoying Luo  (罗晓颖), Gezhi Zhang  (张格知), Shuangshuang Fang  (方霜霜), Sijing Du  (独思静), Yang Yang  (杨洋) & Wei Wei  (魏玮)

  2. Beijing University of Chinese Medicine, Beijing, 100029, China

    Zijing Tao  (陶紫晶) & Zeng Cao  (曹增)

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  1. Zijing Tao  (陶紫晶)
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Contributions

WEI Wei was responsible for the design and conception of this study. TAO Zijing and CAO Zeng conducted statistical analysis, graph drawing, and manuscript writing; LIU Qian, ZHANG Gezhi, FANG Shuangshuang, YANG Yang, and DU Sijing were responsible for searching databases, screening documents, extracting data, and evaluating methodological quality; all authors critically revised the manuscript.

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Correspondence to Wei Wei  (魏玮).

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Tao, Z., Cao, Z., Liu, Q. et al. Tuina treatment for children and adults with functional dyspepsia: a meta-analysis and systematic review of randomized controlled trials. J. Acupunct. Tuina. Sci. 21, 413–426 (2023). https://doi.org/10.1007/s11726-023-1400-6

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