针刺治疗腰椎间盘突出症的应用进展及临床研究方法学质量：现状、问题与改进策略

Advances in the Application of Acupuncture for Lumbar Disc Herniation and Methodological Quality of Clinical Research: Current Status, Problems, and Improvement Strategies

摘要: 腰椎间盘突出症(LDH)是引发腰腿疼痛与功能障碍的主要脊柱退行性疾病，针刺为其重要非手术治疗手段。本综述旨在系统梳理针刺治疗 LDH 的作用机制、临床疗法及方法学质量现状。研究表明，针刺通过抑制NF-κB、MAPK信号通路及下调IL-1β、TNF-α等炎性因子水平，发挥抗炎、镇痛效应，体针、电针等单一及复合疗法可显著改善患者VAS、ODI评分。但相关临床研究方法学质量整体处于中等偏下水平，随机化实施、盲法应用等关键环节存在缺陷，导致偏倚风险较高，限制了循证证据等级提升。未来需聚焦高质量多中心研究、多维疗效评价体系构建等核心方向，推动针刺治疗LDH从经验医学向循证医学跨越。

Abstract: Lumbar Disc Herniation (LDH) is a major degenerative spinal disorder causing lumbocrural pain and functional impairment, and acupuncture serves as an important non-surgical treatment modality for it. This review aims to systematically summarize the mechanisms of action, clinical therapies, and current status of methodological quality of acupuncture in the treatment of LDH. Evidence shows that acupuncture exerts anti-inflammatory and analgesic effects by inhibiting Nuclear Factor-κB (NF-κB) and Mitogen-Activated Protein Kinase (MAPK) signaling pathways, as well as downregulating the levels of pro-inflammatory cytokines such as Interleukin-1β (IL-1β) and Tumor Necrosis Factor-α (TNF-α). Both standalone therapies (e.g., body acupuncture, electroacupuncture) and combined therapies can significantly improve patients' Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. However, the overall methodological quality of relevant clinical studies is moderately low, with deficiencies in key aspects such as randomization implementation and blinding application, leading to a high risk of bias and restricting the improvement of the quality of evidence-based evidence. In the future, efforts should focus on core directions including high-quality multicenter studies and the construction of a multidimensional efficacy evaluation system, so as to promote the transformation of acupuncture for LDH from empirical medicine to evidence-based medicine.