Ci-dessous, les différences entre deux révisions de la page.

Lien vers cette vue comparative

Les deux révisions précédentes Révision précédente
Prochaine révision
Révision précédente
acupuncture:evaluation:gastro-enterologie:10. hepatite [07 Nov 2019 06:42]
Nguyen Johan Page name changed from acupuncture:evaluation:gastro-enterologie:10. pathologies hepatiques to acupuncture:evaluation:gastro-enterologie:10. hepatite
acupuncture:evaluation:gastro-enterologie:10. hepatite [07 Nov 2019 06:47] (Version actuelle)
Nguyen Johan
Ligne 1: Ligne 1:
-====== ​Pathologies hépatiques ​: évaluation de l'​acupuncture ======+====== ​Hépatite ​: évaluation de l'​acupuncture ======
 ===== Revues systématiques et méta-analyses ​ ===== ===== Revues systématiques et méta-analyses ​ =====
-==== Verma 2007 =====+| ☆☆☆ | Preuves en faveur d’une efficacité et d’un effet spécifique de l’acupuncture | 
 +| ☆☆ | Preuves en faveur d’une efficacité de l’acupuncture | 
 +| ☆ |Preuves limitées en faveur d’une efficacité de l’acupuncture | 
 +| Ø |Absence de preuve ou preuves insuffisantes | 
 +==== Kong 2019 ==== 
 +Kong Z, Liang N, Yang GL, Zhang Z, Liu Y, Yang Y, Liu YX, Wang QG, Zhang F, Zhang HY, Nikolova D, Jakobsen JC, Gluud C, Liu JP. Acupuncture for chronic hepatitis B. Cochrane Database Syst Rev. 2019.   ​[201948].  
 +^Background|Chronic hepatitis B is a liver disease associated with high morbidity and mortality. Chronic hepatitis B requires long-term management aiming to reduce the risks of hepatocellular inflammatory necrosis, liver fibrosis, decompensated liver cirrhosis, liver failure, and liver cancer, as well as to improve health-related quality of life. Acupuncture is being used to decrease discomfort and improve immune function in people with chronic hepatitis B. However, the benefits and harms of acupuncture still need to be established in a rigorous way. | 
 +^Objectives| To assess the benefits and harms of acupuncture versus no intervention or sham acupuncture in people with chronic hepatitis B. | 
 +^Methods|SEARCH METHODS: We undertook electronic searches of the Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, LILACS, Science Citation Index Expanded, Conference Proceedings Citation Index - Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data, and SinoMed to 1 March 2019. We also searched the World Health Organization International Clinical Trials Registry Platform (www.who.int/​ictrp),​ ClinicalTrials.gov (www.clinicaltrials.gov/​),​ and the Chinese Clinical Trial Registry (ChiCTR) for ongoing or unpublished trials until 1 March 2019. SELECTION CRITERIA: We included randomised clinical trials, irrespective of publication status, language, and blinding, comparing acupuncture versus no intervention or sham acupuncture in people with chronic hepatitis B. We included participants of any sex and age, diagnosed with chronic hepatitis B as defined by the trialists or according to guidelines. We allowed co-interventions when the co-interventions were administered equally to all intervention groups. DATA COLLECTION AND ANALYSIS: Review authors in pairs individually retrieved data from reports and through correspondence with investigators. Primary outcomes were all-cause mortality, proportion of participants with one or more serious adverse events, and health-related quality of life. Secondary outcomes were hepatitis B-related mortality, hepatitis B-related morbidity, and adverse events considered not to be serious. We presented the pooled results as risk ratios (RRs) with 95% confidence intervals (Cis). We assessed the risks of bias using risk of bias domains with predefined definitions. We put more weight on the estimate closest to zero effect when results with fixed-effect and random-effects models differed. We evaluated the certainty of evidence using GRADE. | 
 +^ Main results| We included **eight randomised clinical trials with 555 randomised participants**. All included trials compared acupuncture versus no intervention. These trials assessed heterogeneous acupuncture interventions. All trials used heterogeneous co-interventions applied equally in the compared groups. Seven trials included participants with chronic hepatitis B, and one trial included participants with chronic hepatitis B with comorbid tuberculosis. All trials were assessed at overall high risk of bias, and the certainty of evidence for all outcomes was very low due to high risk of bias for each outcome, imprecision of results (the confidence intervals were wide), and publication bias (small sample size of the trials, and all trials were conducted in China). Additionally,​ 79 trials lacked the necessary methodological information to ensure their inclusion in our review.None of the included trials aim to assess all-cause mortality, serious adverse events, health-related quality of life, hepatitis B-related mortality, and hepatitis B-related morbidity. We are uncertain whether acupuncture,​ compared with no intervention,​ has an effect regarding adverse events considered not to be serious (RR 0.67, 95% CI 0.43 to 1.06; I² 0%; 3 trials; 203 participants;​ very low-certainty evidence) or detectable hepatitis B e-antigen (HBeAg) (RR 0.64, 95% CI 0.11 to 3.68; I² = 98%; 2 trials; 158 participants;​ very low-certainty evidence). Acupuncture showed a reduction in detectable hepatitis B virus (HBV) DNA (a non-validated surrogate outcome; RR 0.45, 95% CI 0.27 to 0.74; 1 trial, 58 participants;​ very low-certainty evidence). We are uncertain whether acupuncture has an effect regarding the remaining separately reported adverse events considered not to be serious.Three of the eight included trials received academic funding from government or hospital. None of the remaining five trials reported information on funding. | 
 +^Authors'​ conclusions| The clinical effects of acupuncture for chronic hepatitis B remain unknown. The included trials lacked data on all-cause mortality, health-related quality of life, serious adverse events, hepatitis-B related mortality, and hepatitis-B related morbidity. The vast number of excluded trials lacked clear descriptions of their design and conduct. Whether acupuncture influences adverse events considered not to be serious is uncertain. It remains unclear if acupuncture affects HBeAg, and if it is associated with reduction in detectable HBV DNA. Based on available data from only one or two small trials on adverse events considered not to be serious and on the surrogate outcomes HBeAg and HBV DNA, the certainty of evidence is very low. In view of the wide usage of acupuncture,​ any conclusion that one might try to draw in the future should be based on data on patient and clinically relevant outcomes, assessed in large, high-quality randomised sham-controlled trials with homogeneous groups of participants and transparent funding. |
-Verma S, Thuluvath PJ. Complementary and Alternative Medicine in Hepatology: Review of the Evidence of Efficacy. Clin Gastroenterol Hepatol. 2007;​5(4):​408-16. {{:​medias+securises:​acupuncture:​evaluation:​gastro-enterologie:​verma-145566.pdf|[145566]}}. <wrap lo>There is an increase in the use of complementary and alternative medicine (CAM), especially herbal therapy, among patients with liver disease. The most commonly used herbal agent is silymarin. In animal models, many of the commonly used agents have shown anti-inflammatory and antifibrotic effects. Although many human studies have shown improvements in subjective symptoms (well being) and liver biochemistry,​ there are no convincing data to suggest a definite histologic and/or virologic improvement with most of these agents. Poorly designed studies, heterogeneous patient populations,​ lack of standardized preparations,​ and poorly defined nonobjective end points may partly explain the conflicting reports in the literature. Hepatotoxicity and drug interactions are common with many herbal medications,​ and therefore physicians need to be cognizant of known or occult use of CAM by their patients. Only well-designed,​ randomized, controlled trials will be able to ascertain whether CAM has any role in the management of patients with acute or chronic liver diseases. Until such time, the use of CAM cannot be recommended as a therapy for patients with liver disease</​wrap>​