Data Sheet 4_Efficacy of acupuncture as adjunctive therapy for patients with acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis.docx

BackgroundChronic obstructive pulmonary disease (COPD) is a highly prevalent and potentially fatal respiratory condition. Acute exacerbations can accelerate lung function decline and increase mortality. Acupuncture has been increasingly used as an adjunctive treatment for respiratory diseases, but its effectiveness in acute exacerbations of COPD (AECOPD) remains controversial. Existing evaluations on this topic are limited in scope and depth. This study aimed to provide a more comprehensive review to evaluate the effectiveness of acupuncture as an adjuvant treatment for acute exacerbations of chronic obstructive pulmonary disease.
Study designSystematic review and meta-analysis of existing randomized controlled trials on acupuncture-assisted treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
MethodsWe included randomized controlled trials (RCTs) comparing acupuncture combined with conventional Western medicine to conventional Western medicine alone in patients with acute exacerbations of COPD (AECOPD). Our literature search covered ten databases, including PubMed and Web of Science ect., up until March 2025. The primary outcome was the effective rate, while secondary outcomes included lung function (FEV1%, FEV1/FVC%, FEV1), arterial blood gas analysis (PaO2, PaCO2, SaO2), the 6-min walk test (6MWT), COPD Assessment Test (CAT), modified Medical Research Council (mMRC) scale, and success rate of weaning. Data were extracted from eligible studies, and statistical analysis was performed using RevMan 5.3 and Stata 16.0. Risk of bias and evidence quality were assessed using Cochrane tools and GRADE methodology.
ResultsThe study included 31 randomized controlled trials (RCTs) with 2,299 participants. The studies were primarily conducted in hospital inpatient departments, and the typical treatment duration ranged from 1 to 2 weeks. Compared with conventional Western medicine alone, acupuncture combined with conventional Western medicine showed greater effectiveness (RR = 1.23, 95%CI 1.17 ~ 1.29, p < 0.001). Acupuncture significantly improved lung function (FEV1%: MD = 5.67, 95%CI 2.97 ~ 8.37, p < 0.001; FEV1/FVC: MD = 4.44, 95%CI 1.86 ~ 7.03, p < 0.001; FEV1: MD = 0.37, 95%CI 0.26 ~ 0.47, p < 0.001), reduced hypoxia (PaO2: MD = 3.60, 95%CI 2.23 ~ 4.98, p < 0.001; PaCO2: MD = -3.30, 95%CI -5.80 ~ −0.80, p < 0.05; SaO2: MD = 4.23, 95%CI 3.02 ~ 5.43, p < 0.001), and improved exercise tolerance (6MWT: MD = 40.34, 95%CI 30.50 ~ 50.17, p < 0.001), quality of life (CAT: MD = -2.68, 95%CI -3.39 ~ −1.96, p < 0.001), and dyspnea (mMRC: MD = -0.33, 95%CI -0.47 ~ −0.20, p < 0.001). However, the weaning success rate did not show a statistically significant difference between the two groups (RR = 1.18, 95%CI 0.95 ~ 1.48, p = 0.14). Mild side effects were reported in some studies. We rated the quality of evidence as very low to medium.
ConclusionThis systematic review and meta-analysis demonstrate that acupuncture, as an adjunctive treatment for acute exacerbations of chronic obstructive pulmonary disease, improves clinical efficacy and key outcomes. Our findings are consistent with previous studies that demonstrated improvements in the COPD Assessment Test (CAT) and arterial blood gas parameters (PaO2 and PaCO2). Unlike previous meta-analyses, the present study showed that adjunctive acupuncture significantly improved patient lung function FEV1% outcomes and significantly improved patient 6-min walk distance and modified Medical Research Council (mMRC) score; however, there was no significant difference in the success rate of weaning between the two groups. Although the review highlights clinical benefits, the heterogeneity of the included studies and the overall quality of the evidence suggest that more high-quality randomized controlled trials are needed to validate these findings and optimize treatment strategies. These studies should also prioritize standardizing acupuncture regimens, extending treatment duration, and conducting long-term follow-up assessments.
Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/ ID:CRD42024528155.

背景 慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease, COPD）是一种患病率极高且可致命的呼吸系统疾病。急性加重期可加速肺功能下降并升高病死率。针灸作为呼吸系统疾病的辅助治疗手段应用日益广泛，但其用于慢性阻塞性肺疾病急性加重期（Acute Exacerbation of Chronic Obstructive Pulmonary Disease, AECOPD）的疗效仍存在争议。目前针对该主题的评价研究在范围与深度上均存在局限。本研究旨在开展更为全面的系统评价，以评估针灸作为辅助治疗手段用于慢性阻塞性肺疾病急性加重期的临床疗效。
研究设计 本研究为针对针灸辅助治疗慢性阻塞性肺疾病急性加重期（AECOPD）的现有随机对照试验开展的系统评价与Meta分析。
方法 本研究纳入对比针灸联合常规西医治疗与单纯常规西医治疗用于慢性阻塞性肺疾病急性加重期（AECOPD）患者疗效的随机对照试验（Randomized Controlled Trial, RCT）。文献检索覆盖截至2025年3月的10个数据库，包括PubMed、Web of Science等。主要结局指标为临床有效率，次要结局指标包括肺功能指标[第一秒用力呼气容积占预计值百分比（FEV1%）、第一秒用力呼气容积与用力肺活量比值（FEV1/FVC%）、第一秒用力呼气容积（FEV1）]、动脉血气分析指标[动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、动脉血氧饱和度（SaO2）]、6分钟步行试验（6-Minute Walk Test, 6MWT）、慢性阻塞性肺疾病评估测试（COPD Assessment Test, CAT）、改良英国医学研究委员会呼吸困难量表（modified Medical Research Council, mMRC）以及脱机成功率。从符合纳入标准的研究中提取数据，采用RevMan 5.3与Stata 16.0软件开展统计学分析。采用Cochrane偏倚风险评估工具与GRADE证据分级方法评价偏倚风险与证据质量。
结果 本研究共纳入31项随机对照试验（RCT），涉及2299名受试者。此类研究主要在医院住院病房开展，典型治疗周期为1~2周。与单纯常规西医治疗相比，针灸联合常规西医治疗的临床有效率更高（相对危险度RR=1.23，95%置信区间CI：1.17~1.29，P<0.001）。针灸联合治疗可显著改善肺功能[FEV1%：均数差MD=5.67，95%CI：2.97~8.37，P<0.001；FEV1/FVC：MD=4.44，95%CI：1.86~7.03，P<0.001；FEV1：MD=0.37，95%CI：0.26~0.47，P<0.001]，缓解低氧血症[PaO2：MD=3.60，95%CI：2.23~4.98，P<0.001；PaCO2：MD=-3.30，95%CI：-5.80~-0.80，P<0.05；SaO2：MD=4.23，95%CI：3.02~5.43，P<0.001]，提升运动耐量[6MWT：MD=40.34，95%CI：30.50~50.17，P<0.001]、改善生活质量[CAT：MD=-2.68，95%CI：-3.39~-1.96，P<0.001]及缓解呼吸困难[mMRC：MD=-0.33，95%CI：-0.47~-0.20，P<0.001]。但两组脱机成功率差异无统计学意义（RR=1.18，95%CI：0.95~1.48，P=0.14）。部分研究报告了轻微不良反应。本研究对证据质量的评级为极低至中等质量。
结论 本项系统评价与Meta分析显示，针灸作为慢性阻塞性肺疾病急性加重期的辅助治疗手段，可提升临床疗效与关键结局指标。本研究结果与既往研究一致，均证实针灸可改善慢性阻塞性肺疾病评估测试（CAT）评分与动脉血气参数（PaO2、PaCO2）。与既往Meta分析不同的是，本研究显示辅助针灸治疗可显著改善患者肺功能FEV1%指标、6分钟步行距离及改良英国医学研究委员会呼吸困难量表（mMRC）评分，但两组脱机成功率无显著差异。尽管本研究证实了针灸的临床获益，但纳入研究的异质性与整体证据质量提示，仍需开展更多高质量随机对照试验以验证本研究结果并优化治疗方案。此类研究应优先规范针灸治疗方案、延长治疗周期并开展长期随访评估。
系统评价注册信息 注册平台：https://www.crd.york.ac.uk/prospero/，注册编号：CRD42024528155。