不同针刺方式治疗黄褐斑的贝叶斯网状Meta分析*

作者：肖 欣1，向聪莲2，文楚欣2，杨义成2

单位：1.广州中医药大学深圳中西医结合临床医学院，广东 深圳 518104； 2.深圳市中西医结合医院，广东 深圳 518104

引用：引用：肖欣，向聪莲，文楚欣，杨义成.不同针刺方式治疗黄褐斑的贝叶斯网状Meta分析[J].中医药导报,2026,32(5):197-202,235.

DOI：10.13862/j.cn43-1446/r.2026.05.031

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摘要：

目的：采用贝叶斯网状Meta分析系统评价不同针刺方式治疗黄褐斑的临床疗效。方法：通过检索电子文献库中国知网、中国生物医学文献服务系统、万方数据知识服务平台、维普中文期刊服务平台、PubMed、Web of Science、Cochrane Library和Embase数据库中针刺治疗黄褐斑的随机对照试验，检索时限为建库至2025年5月27日。由研究人员网络检索、筛选文献、提取数据、纳入符合标准的文献，并使用Cochrane偏倚风险评估工具对其进行质量评估，最后运用R Studio软件，以临床有效率和积分下降指数作为观察的结局指标，对最终纳入的文献进行贝叶斯网状Meta分析。结果：共纳入17篇文献，涉及11种干预措施，试验组766例，对照组807例，共计1 573例患者。网状Meta分析结果显示，刺络放血、埋线、围刺+埋线、常规针刺+埋线、常规针刺+梅花针的临床有效率显著优于常规针刺（P<0.05）；不同干预措施患者的皮损积分下降指数比较，差异均无统计学意义（P>0.05）；提高临床有效率的各种干预措施排序为：围刺+埋线＞常规针刺+埋线＞常规针刺+梅花针＞刺络放血＞穴位注射＞埋线＞常规针刺+火针＞围刺＞常规针刺+刺络放血＞围刺+刺络放血＞常规针刺；改善皮损面积下降指数的各种干预措施排序为：常规针刺＞常规针刺+梅花针＞埋线＞围刺＞刺络放血＞常规针刺+刺络放血＞穴位注射＞围刺+埋线＞围刺+刺络放血；临床有效率和皮损总评分下降指数的漏斗图提示发表偏倚的风险可能性较高。结论：围刺联合埋线提高临床有效率的效果显著，常规针刺在改善皮损积分下降指数方面优势明显，但仍有待通过更多严谨且数据详实的高质量临床试验进一步验证。

关键词：黄褐斑；针刺；围刺；刺络放血；梅花针；埋线；网状Meta分析

Abstract：

Objective: To systematically evaluate the clinical efficacy of different acupuncture methods in the treatment of melasma using Bayesian network Meta-analysis. Methods: Randomized controlled trials (RCTs) of acupuncture for melasma were retrieved from China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Service System (SinoMed), Wanfang Data Knowledge Service Platform (Wanfang Data), China Science and Technology Journal Database (CSTJ), PubMed, Web of Science, Cochrane Library and Embase databases from the establishment of the databases to May 27, 2025. Researchers conducted online retrieval, screened literature, extracted data, included literature that met the criteria, and used the Cochrane Risk of Bias Assessment Tool to evaluate its quality. Finally, R Studio software was used to perform Bayesian network meta-analysis on the finally included literature, with clinical effective rate and lesion score reduction index as the outcome indicators. Results: A total of 17 literature were included, involving 11 intervention measures, with 766 cases in the experimental group and 807 cases in the control group, totaling 1 573 patients. The results of network meta-analysis showed that collateral-pricking bloodletting, thread embedding, surrounding acupuncture + thread embedding, conventional acupuncture + thread embedding, and conventional acupuncture + plum-blossom needle were significantly superior to conventional acupuncture in clinical effective rate (P<0.05). There was no statistically significant difference in the lesion score reduction index among patients with different intervention measures (P>0.05). The ranking of various intervention measures for improving clinical effective rate was as follows: surrounding acupuncture + thread embedding > conventional acupuncture + thread embedding > conventional acupuncture + plum-blossom needle > collateral-pricking bloodletting > acupoint injection > thread embedding > conventional acupuncture + fire needle > surrounding acupuncture > conventional acupuncture + collateral-pricking bloodletting > surrounding acupuncture + collateral-pricking bloodletting > conventional acupuncture. The ranking of various intervention measures for improving lesion area reduction index was as follows: conventional acupuncture > conventional acupuncture + plum-blossom needle > thread embedding > surrounding acupuncture > collateral-pricking bloodletting > conventional acupuncture + collateral-pricking bloodletting > acupoint injection > surrounding acupuncture + thread embedding > surrounding acupuncture + collateral-pricking bloodletting. Funnel plots of clinical effective rate and total lesion score reduction index suggested a relatively high risk of publication bias. Conclusion: Surrounding acupuncture combined with thread embedding has a significant effect in improving clinical effective rate, while conventional acupuncture has obvious advantages in improving lesion score reduction index. However, it still needs to be further verified by more rigorous and data-detailed high-quality clinical trials.

Key words：melasma; acupuncture; surrounding acupuncture; collateral-pricking bloodletting; plum-blossom needle; thread embedding; network Meta-analysis

发布时间：2026-05-24

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