中医外治法治疗乳腺增生症的网状Meta分析

A Systematic Review and Network Meta-Analysis of Traditional Chinese Medicine External Treatment on Hyperplasia of Mammary Glands

摘要: 目的：通过网状Meta分析系统性评价不同中医外治方法对乳腺增生症的临床疗效。方法：检索中国知网、万方数据知识服务平台、维普资讯中文期刊服务平台、中国生物医学文献服务、PubMed、Cochrane Library、Web of Science数据库，搜集从建库至2024年10月31日公开发表的中医外治法治疗乳腺增生的随机对照试验。经筛选文献、质量评价、提取资料后，使用RevMan5.4和Stata18.0进行网状Meta分析和图形绘制。结果：共纳入111篇文献，涉及11种中医外治法，28种干预组合。在当前证据条件下，针刺 + 中药外敷、针刺 + 拔罐在改善治疗有效率、乳房疼痛及肿块相关指标方面显示出相对较好的效应量趋势，但受纳入研究整体质量偏低、部分结局置信区间较宽等因素影响，效应估计存在较大不确定性，尚不能得出“最优”的确定性结论。上述结果基于现有低质量证据，仍需未来开展更多高质量、大样本、严谨盲法与分配隐藏的随机对照试验加以验证。临床决策时，应综合考虑患者意愿、身体状况等多方面因素。

Abstract: Objective: To systematically evaluate the clinical efficacy of different traditional Chinese medicine (TCM) external treatments for hyperplasia of mammary glands through a network meta-analysis. Methods: Databases including CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, and Web of Science were searched for randomized controlled trials (RCTs) of TCM external treatments on hyperplasia of mammary glands from the establishment of the databases to October 31, 2024. After screening the literature, evaluating the quality, and extracting the data, RevMan 5.4 and Stata 18.0 were used for network meta-analysis and graph drawing. Results: A total of 111 RCTs were included, involving 11 TCM external treatments and 28 intervention combinations. Under the current evidence base, acupuncture combined with external application of Chinese medicine and acupuncture combined with cupping showed relatively favorable effect-size trends in improving the treatment effective rate, breast pain, and lump-related outcomes. However, owing to the overall low quality of the included studies and the wide 95% confidence intervals observed for several outcomes, the effect estimates are subject to considerable uncertainty, and no definitive “optimal” conclusion can be drawn. These findings are based on currently low-quality evidence and require confirmation by future high-quality, large-sample RCTs with rigorous blinding and allocation concealment. Multiple factors such as patient preferences and physical conditions should be considered in clinical decision-making.