Results of network meta-analysis.

Background
Combination therapy of α-receptor blockers (α-RBs) and traditional Chinese medicine external therapy can serve as a treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). α-RBs includes tamsulosin, terazosin and so on and the traditional Chinese medicine external therapy includes needling, moxibustion, acupoint catgut embedding, acupoint application, auricular point sticking and hot medicated compress and so forth. Currently, there is no study in which Bayesian network meta-analysis is applied to making a comparative analysis of efficacy of different combination therapies of α-RBs and traditional Chinese medicine external therapy in the treatment of CP/CPPS. Therefore, based on Bayesian algorithm, a network meta-analysis was conducted by us to make a comparison between different combination therapies of α-RBs and traditional Chinese medicine external therapy.
Methods
A document retrieval was conducted in the databases PubMed, Cochrane Library, Embase, Web of science, China National Knowledge Infrastructure, WanFang Data Dissertations of China database, VIP China Science and Technology Journal Database, SinoMed. Literatures were searched for published in biomedical journals concerning clinical study on α-RBs combined with various traditional Chinese medicine external therapies in the treatment of CP/CPPS from inception of database to July 2022. Newest version risks of bias assessment tool (RoB2) was used to assess the risks of bias of studies included in this analysis. Stata 16.0 software and R4.1.3 software were used to make a Bayesian network meta-analysis and charts.
Results
19 literatures were included involving 1739 patients concerning 12 interventions which were used in the treatment of CP/CPPS. With respect to the total effective rate, α-RBs+ needling was most likely to be the optimal treatment. Concerning National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score, α-RBs+ moxibustion+ auricular point sticking was most likely to be optimal treatment, the therapy ranking second was α-RBs+ needling, and the therapy ranking third was α-RBs+ moxibustion. Pain score, voiding score and quality-of-life score are subdomains of the NIH-CPSI total score. With regard to pain score, α-RBs+ moxibustion was most likely to be optimal treatment. In reference to voiding and quality-of-life score, there was no statistically significant difference between the efficacy of various interventions.
Conclusions
α-RBs+ needling, α-RBs+ moxibustion and α-RBs+ moxibustion+ auricular point sticking provided relatively good efficacy in the treatment of CP/CPPS. In these treatments, attention should be paid on α-RBs+ needling and α-RBs+ moxibustion which ranked higher many times in the evaluation of various outcome indicators. However, there still were certain limitations in this study, so large-sample clinical randomized control trials with a rigor design following the evidence-based medicine standards need to be conducted to justify the results of this study.
Systematic review registration
[https://www.crd.york.ac.uk/prospero/], identifier: [CRD42022341824].

# 背景
α受体阻滞剂（α-receptor blockers，α-RBs）联合传统中医外治法可用于治疗慢性前列腺炎/慢性盆腔疼痛综合征（chronic prostatitis/chronic pelvic pain syndrome，CP/CPPS），其中α受体阻滞剂包括坦索罗辛、特拉唑嗪等，传统中医外治法包括针刺、艾灸、穴位埋线、穴位贴敷、耳穴压豆及中药热敷等。目前尚无研究采用贝叶斯网络元分析（Bayesian network meta-analysis）对不同α受体阻滞剂联合传统中医外治法治疗CP/CPPS的疗效开展比较分析。为此，本研究基于贝叶斯算法开展网络元分析，对比不同α受体阻滞剂联合传统中医外治法的治疗效果。

# 方法
本研究检索了PubMed、Cochrane Library、Embase、Web of Science、中国知网（China National Knowledge Infrastructure）、万方中国学位论文全文数据库（WanFang Data Dissertations of China database）、维普中文科技期刊数据库（VIP China Science and Technology Journal Database）及中国生物医学文献服务系统（SinoMed），检索时限为各数据库建库至2022年7月，纳入所有发表于生物医学期刊的、关于α受体阻滞剂联合不同传统中医外治法治疗CP/CPPS的临床研究。采用最新版偏倚风险评估工具（RoB2）对纳入研究的偏倚风险进行评价，使用Stata 16.0及R 4.1.3软件完成贝叶斯网络元分析及图表绘制。

# 结果
共纳入19项研究，涉及1739例患者，包含12种用于治疗CP/CPPS的干预措施。以总有效率为结局指标时，α受体阻滞剂联合针刺疗法最有可能成为最优治疗方案。以美国国立卫生研究院慢性前列腺炎症状指数（National Institutes of Health Chronic Prostatitis Symptom Index，NIH-CPSI）总评分为结局指标时，α受体阻滞剂联合艾灸联合耳穴压豆疗法最有可能成为最优治疗方案，排名第二的为α受体阻滞剂联合针刺疗法，排名第三的为α受体阻滞剂联合艾灸疗法。疼痛评分、排尿评分及生活质量评分均为NIH-CPSI总评分的子维度；以疼痛评分为结局指标时，α受体阻滞剂联合艾灸疗法最有可能成为最优治疗方案。针对排尿评分及生活质量评分，各干预措施的疗效差异无统计学意义。

# 结论
α受体阻滞剂联合针刺疗法、α受体阻滞剂联合艾灸疗法及α受体阻滞剂联合艾灸联合耳穴压豆疗法治疗CP/CPPS均具有较好的疗效；其中，α受体阻滞剂联合针刺疗法及α受体阻滞剂联合艾灸疗法在多项结局指标评价中排名均较为靠前，值得关注。但本研究仍存在一定局限性，未来需开展遵循循证医学标准、设计严谨的大样本临床随机对照试验以验证本研究结果。

# 系统评价注册信息
系统评价注册平台：[https://www.crd.york.ac.uk/prospero/]，注册号：[CRD42022341824]。