[Randomized controlled trial evidence and physicians' clinical concerns in acupuncture treatment for eczema: a comparative study].

内容摘要

To compare the differences between randomized controlled trial (RCT) evidence and physicians' clinical concerns in acupuncture treatment for eczema, and to provide a basis for optimizing clinical practice and future research. RCTs on acupuncture for eczema were systematically searched in CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, and Web of Science databases from inception to December 31, 2023. Evidence from RCTs on acupuncture treatment for eczema was collected and methodological quality was evaluated. A questionnaire on clinical concerns regarding acupuncture treatment for eczema was designed, covering population characteristics (population age, disease type, TCM syndrome), acupuncture intervention measures (types of acupuncture therapies and components of acupuncture protocols), types of control measures of concern, outcome, and selection of evaluation time points. The questionnaire was distributed nationwide among clinicians to investigate their concerns regarding acupuncture treatment for eczema. Differences and similarities between RCT evidence and physicians' clinical concerns were compared across five dimensions: study population, intervention measures, control setting, outcome, and evaluation time points. A total of 243 RCTs and 87 valid questionnaires were included. The RCTs presented certain risks of bias. The evidence was mainly concentrated on chronic eczema of spleen deficiency with dampness excess in adolescents and adults, with insufficient attention to infants, pregnant and postpartum women, and acute/subacute eczema. The intervention measures were mainly filiform needle acupuncture, fire needle, and moxibustion; however, descriptions of acupuncture parameters and treatment courses were insufficient, and there was a lack of studies on intradermal needles and auricular acupoint pressing. Control interventions were mostly glucocorticoids for external use or antihistamines, which were not entirely consistent with clinicians' concerns regarding calcineurin inhibitors, biologics, and other modern therapeutic strategies. Outcomes mainly focused on effective rate and severity scores such as skin lesions and pruritus, whereas clinicians were more concerned with multidimensional outcomes such as quality of life, psychological status, patient satisfaction, recurrence rate, and medication use. Most studies focused only on short-term efficacy at the end of treatment, lacking data on immediate efficacy and long-term follow-up, which did not align with clinical concerns about sustained efficacy and recurrence risk. There are certain differences between current RCT evidence and physicians' clinical concerns regarding acupuncture treatment for eczema. Future research should be guided by clinical questions, optimize population stratification design, refine descriptions of acupuncture intervention parameters, introduce more clinically relevant control groups, construct multidimensional outcome systems, and implement full-course efficacy evaluation to improve the quality of evidence and clinical applicability of acupuncture treatment for eczema. 目的：比较针灸治疗湿疹的随机对照试验（RCT）证据与医生临床关注之间的差异，为优化临床实践及未来研究提供依据。 方法：检索中国期刊全文数据库（CNKI）、万方数据知识服务平台（Wanfang）、维普资讯中文期刊服务平台（VIP）、中国生物医学文献数据库（SinoMed）、PubMed、EMbase、Cochrane Library及Web of Science数据库建库以来至2023年12月31日收录的有关针灸治疗湿疹的RCT文献，收集针灸治疗湿疹的RCT证据并进行方法学质量评价。设计针灸治疗湿疹的临床关注调查问卷，内容涉及人群特征（人群年龄、疾病类型、中医证型）、针灸干预措施（针灸疗法种类、针灸方案要素）、应关注的对照措施种类、结局指标及评价时点的选择等，并在全国范围的临床医生中发放，了解临床医生对针灸治疗湿疹的关注问题。围绕研究人群、干预措施、对照设置、结局指标和评价时点5个维度，比较RCT证据与临床医生关注的异同。 结果：共纳入243篇RCT和87份有效调查问卷。RCT存在一定的偏倚风险，证据多集中于青少年及成年人脾虚湿盛证的慢性湿疹，对婴幼儿、孕产妇及急性/亚急性湿疹关注不足；干预措施以毫针刺、火针和灸法为主，但针灸参数及疗程等信息描述不充分，缺乏对皮内针、耳穴贴压等便捷疗法的研究；对照措施多为外用糖皮质激素或抗组胺药物，与临床医生关注的钙调磷酸酶抑制剂、生物制剂等现代新型治疗策略不完全一致；结局侧重在有效率以及皮损、瘙痒等疾病严重程度评分，而临床医生更关注生活质量、精神心理状态、患者满意度、复发率及用药情况等多维度结局；多数研究仅关注治疗结束时的短期疗效，缺乏即刻疗效及长期随访数据，与临床对疗效持续性和复发风险的关注存在差异。 结论：当前针灸治疗湿疹的RCT证据与医生临床关注间存在一定的差异。未来研究应以临床问题为导向，优化人群分层设计，细化针灸干预参数，引入更具现实意义的对照组，构建多维度结局体系并实施全过程疗效评估，以提升针灸治疗湿疹研究的证据质量与临床适用性。.