一陰一陽：JAMA發表兩篇中國針灸報告

Genomics and Precision Health

（圖片來自文章插圖）

【紐約中醫論壇首發】

美國醫學會雜誌JAMA於2017年6月27日同刊發表了兩篇來自中國的針灸研究報告。一個來自黑龍江中醫藥大學等醫院的研究表明針刺治療多囊卵巢不孕症無效；另一個來自中國中醫科學院等醫院的研究證明針灸治療女性壓力性尿失禁確實有效。

中國針灸研究團隊能把臨床研究成果發表在世界一流的醫學雜誌上是件非常有意義的事，反應了中國近年來中醫藥研究的進步和科研資金的充足。

JAMA 雜誌多年來發表的有關針灸的文章質疑多於肯定，這次發表的「一陰一陽」兩文令人深思，反應了臨床針灸科學研究的現狀。說明用嚴格的科學方法證明針灸的臨床療效是可行的，引起了主流醫學的重示，具有臨床指導意義。

有評論認為，美國因濫用止痛藥葯已經造成了巨大的社會問題，針灸作為一種非藥物療法正面對一個難得的發展契機，科學研究會有助針灸進入主流醫學。還應注意，針灸的實用性、有效性及經濟價值，可能會引發未來中國和美國關於知識產權的爭議。

美國近年興起的神經刺激療法「斯巴克」（SPARC）其實就是針灸療法的變種，但研究和使用者在專利和研究報告中通常隻字不提針灸。

有意思的是，NIH補充整合健康中心主任在同刊JAMA的評論文章中，開頭即引用紐約時報記者賴斯頓在北京的針灸故事，恰好道出了美國針灸的淵源。（李永明）

下面是報道原文

Original Investigation

June 27,2017

A Randomized Clinical Trial

Zhishun Liu, MD, PhD

1

; Yan Liu, MD

2

; Huanfang Xu, MD, PhD

1,3

; et al

Liyun He, MD, PhD

2

;Yuelai Chen, MD, PhD

4

;Lixin Fu, MD, PhD

5

;Ning Li, MD

6

;Yonghui Lu, MD

7

;Tongsheng Su, MD

8

;Jianhua Sun, MD, PhD

9

;Jie Wang, MD, PhD

10

;Zenghui Yue, MD

11

;Wei Zhang, MD, PhD

12

;Jiping Zhao, MD

13

;Zhongyu Zhou, MD

14

;Jiani Wu, MD, PhD

1

;Kehua Zhou, MD, DPT

15

;Yanke Ai, PhD

2

;Jing Zhou, MD

1

;Ran Pang, MD, PhD

1

;Yang Wang, MD, PhD

1

;Zongshi Qin, MD

1

;Shiyan Yan, PhD

2

;Hongjiao Li, MD, PhD

2

;Lin Luo, MD, PhD

2

;Baoyan Liu, MD

1

Author Affiliations

JAMA.2017;317(24):2493-2501. doi:10.1001/jama.2017.7220

Key Points

QuestionIs electroacupuncture involving the lumbosacral region effective in reducing urine leakage for women with stress urinary incontinence?

FindingsIn this randomized clinical trial that included 504 women, the mean decrease in urine leakage, measured by the 1-hour pad test from baseline to week 6, was 9.9 g with electroacupuncture vs 2.6 g with sham electroacupuncture, a significant difference.

MeaningAmong women with stress urinary incontinence, treatment with electroacupuncture involving the lumbosacral region, compared with sham electroacupuncture, resulted in less urine leakage after 6 weeks.

Abstract

ImportanceElectroacupuncture involving the lumbosacral region may be effective for women with stress urinary incontinence (SUI), but evidence is limited.

ObjectiveTo assess the effect of electroacupuncture vs sham electroacupuncture for women with SUI.

Design, Setting, and ParticipantsMulticenter, randomized clinical trial conducted at 12 hospitals in China and enrolling 504 women with SUI between October 2013 and May 2015, with data collection completed in December 2015.

InterventionsParticipants were randomly assigned (1:1) to receive 18 sessions (over 6 weeks) of electroacupuncture involving the lumbosacral region (n?=?252) or sham electroacupuncture (n?=?252) with no skin penetration on sham acupoints.

Main Outcomes and MeasuresThe primary outcome was change from baseline to week 6 in the amount of urine leakage, measured by the 1-hour pad test. Secondary outcomes included mean 72-hour urinary incontinence episodes measured by a 72-hour bladder diary (72-hour incontinence episodes).

ResultsAmong the 504 randomized participants (mean [SD] age, 55.3 [8.4] years), 482 completed the study. Mean urine leakage atbaseline was 18.4 g for the electroacupuncture group and 19.1 g for the sham electroacupuncture group. Mean 72-hour incontinence episodes were 7.9 for the electroacupuncture group and 7.7 for the sham electroacupuncture group. At week 6, the electroacupuncture group had greater decrease in mean urine leakage (?9.9 g) than the sham electroacupuncture group (?2.6 g) with a mean difference of 7.4 g (95% CI, 4.8 to 10.0;P?

During some time periods, the change in the mean 72-hour incontinence episodes from baseline was greater with electroacupuncture than sham electroacupuncture with between-group differences of 1.0 episode in weeks 1 to 6 (95% CI, 0.2-1.7;P?=?.01), 2.0 episodes in weeks 15 to 18 (95% CI, 1.3-2.7;P?

Conclusions and RelevanceAmong women with stress urinary incontinence, treatment with electroacupuncture involving the lumbosacral region, compared with sham electroacupuncture, resulted in less urine leakage after 6 weeks. Further research is needed to understand long-term efficacy and the mechanism of action of this intervention.

Trial Registrationclinicaltrials.gov Identifier: NCT01784172.

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