华中科技大学附属同济医院王伟课题组的一项最新研究探讨了人工针灸预防性治疗无先兆发作性偏头痛的疗效。相关论文于2020年3月25日发表在《英国医学杂志》上。

为了评估人工针灸对初次针灸的无先兆发作性偏头痛患者进行预防性治疗的效果，研究组进行了一项多中心、随机、单盲、对照的临床试验。2016年6月5日至2018年11月15日，研究组在中国的7家医院招募了150例初治的无先兆发作性偏头痛患者，将其随机分组，其中60例接受真正穴位上进行20节人工针灸加常规护理，60例接受在非穴位上加20节非穿透性假针灸加常规护理，30例仅接受常规护理，均治疗8周。

这150名患者的平均年龄为36.5岁，123名（82％）为女性。147名患者纳入最终分析。与假针灸组相比，人工针灸组患者第13-20周的偏头痛天数明显减少，第17-20周的偏头痛发作率显著降低。

第13-16周，人工针灸组患者偏头痛的平均天数减少了3.5天，而假针灸组减少了2.4天；第17-20周时，人工针灸组平均减少3.9天，而假针灸组减少2.2天，差异均具有统计学意义。

第17-20周，人工针灸组的平均发作次数减少了2.3次，而假针灸组减少了1.6次，差异显著。没有严重不良事件的报道。人工针灸和假针灸之间感知针穿透的患者比例没有显著差异，分别为79%和75%。

总之，在预防无先兆发作性偏头痛方面，20节人工针灸优于假针灸和常规护理。临床中可对不愿使用预防性药物或预防性药物无效的患者进行针灸治疗。

附：英文原文

Title: Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial

Author: Shabei Xu, Lingling Yu, Xiang Luo, Minghuan Wang, Guohua Chen, Qing Zhang, Wenhua Liu, Zhongyu Zhou, Jinhui Song, Huitao Jing, Guangying Huang, Fengxia Liang, Hua Wang, Wei Wang

Issue&Volume: 2020/03/25

Abstract: Abstract

Objective To assess the efficacy of manual acupuncture as prophylactic treatment for acupuncture naive patients with episodic migraine without aura.

Design Multicentre, randomised, controlled clinical trial with blinded participants, outcome assessment, and statistician.

Setting Seven hospitals in China, 5 June 2016 to 15 November 2018.

Participants 150 acupuncture naive patients with episodic migraine without aura.

Interventions 20 sessions of manual acupuncture at true acupuncture points plus usual care, 20 sessions of non-penetrating sham acupuncture at heterosegmental non-acupuncture points plus usual care, or usual care alone over 8 weeks.

Main outcome measures Change in migraine days and migraine attacks per four weeks during weeks 1-20 after randomisation compared with baseline (four weeks before randomisation).

Results Among 150 randomised patients (mean age 36.5 (SD 11.4) years; 123 (82%) women), 147 were included in the full analysis set. Compared with sham acupuncture, manual acupuncture resulted in a significantly greater reduction in migraine days at weeks 13 to 20 and a significantly greater reduction in migraine attacks at weeks 17 to 20. The reduction in mean number of migraine days was 3.5 (SD 2.5) for manual versus 2.4 (3.4) for sham (adjusted difference 1.4, 95% confidence interval 2.4 to 0.3; P=0.005) at weeks 13 to 16 and 3.9 (3.0) for manual versus 2.2 (3.2) for sham (adjusted difference 2.1, 2.9 to 1.2; P<0.001) at weeks 17 to 20. At weeks 17 to 20, the reduction in mean number of attacks was 2.3 (1.7) for manual versus 1.6 (2.5) for sham (adjusted difference 1.0, 1.5 to 0.5; P<0.001). No severe adverse events were reported. No significant difference was seen in the proportion of patients perceiving needle penetration between manual acupuncture and sham acupuncture (79% v 75%; P=0.891).

Conclusions Twenty sessions of manual acupuncture was superior to sham acupuncture and usual care for the prophylaxis of episodic migraine without aura. These results support the use of manual acupuncture in patients who are reluctant to use prophylactic drugs or when prophylactic drugs are ineffective, and it should be considered in future guidelines.

DOI: 10.1136/bmj.m697

Source: https://www.bmj.com/content/368/bmj.m697