Objective. To evaluate the clinical effectiveness and safety of acupuncture therapy in the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D) or functional diarrhea (FD) in adults. Method. Five electronic databases—PubMed, EMBASE, CNKI, VIP, and Wanfang—were searched, respectively, until June 8, 2020. The literature of clinical randomized controlled trials of acupuncture for the treatment of IBS-D or FD in adults were collected. Meta-analysis was conducted by Using Stata 16.0 software, the quality of the included studies was assessed by the RevMan ROB summary and graph, and the results were graded by GRADE. Result. Thirty-one studies with 3234 patients were included. Most of the studies were evaluated as low risk of bias related to selection bias, attrition bias, and reporting bias. Nevertheless, seven studies showed the high risk of bias due to incomplete outcome data. GRADE’s assessments were either moderate certainty or low certainty. Compared with loperamide, acupuncture showed more effectiveness in weekly defecation (, 95% CI [-0.49, -0.08]), but no significant improvement in the result of the Bristol stool form (, 95% CI [-0.68, 0.12]). In terms of the drop-off rate, although the acupuncture group was higher than the bacillus licheniformis plus beanxit group (, 95% CI [0.24, 27.65]), loperamide group (, 95% CI [0.57, 2.15]), and trimebutine maleate group (, 95% CI [0.31, 4.53]), respectively, it was lower than the dicetel group (, 95% CI [0.56, 1.23]) and affected the overall trend (, 95% CI [0.67, 1.29]). Besides, acupuncture produced more significant effect than dicetel related to the total symptom score (, 95% CI [-1.42, -0.93]), IBS quality of life (, 95% CI [1.94, 2.80]), recurrence rate (, 95% CI [0.28, 0.66]), and IBS Symptom Severity Scale (, 95% CI [-1.04, -0.47]). Compared to dicetel (, 95% CI [1.18, 1.32]) and trimebutine maleate (, 95% CI [1.13, 1.61]), acupuncture also showed more effective at total efficiency. The more adverse effect occurred in the acupuncture group when comparing with the dicetel group (, 95% CI [1.58, 89.07]) and loperamide group (, 95% CI [0.57, 33.97]), but most of the adverse reactions were mild hypodermic hemorrhage. Conclusion. Acupuncture treatment can improve the clinical effectiveness of IBS-D or FD, with great safety, but the above conclusions need to be further verified through the higher quality of evidence.

中文翻译：

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针灸治疗成人腹泻型肠易激综合征或功能性腹泻：系统评价和荟萃分析

客观的。评价针灸疗法治疗成人腹泻型肠易激综合征（IBS-D）或功能性腹泻（FD）的临床有效性和安全性。方法。分别检索截至2020年6月8日的PubMed、EMBASE、CNKI、维普、万方5个电子数据库。收集针刺治疗成人IBS-D或FD的临床随机对照试验文献。采用Stata 16.0软件进行Meta分析，采用RevMan ROB总结和图表评估纳入研究的质量，并采用GRADE对结果进行分级。结果。纳入了 31 项研究，涉及 3234 名患者。大多数研究被评估为与选择偏倚、损耗偏倚和报告偏倚相关的低偏倚风险。然而，七项研究表明，由于结果数据不完整，存在很高的偏倚风险。GRADE 的评估要么是中等确定性，要么是低确定性。与洛哌丁胺相比，针灸在每周排便方面显示出更有效的效果（， 95% CI [-0.49，-0.08]），但布里斯托大便形式结果没有显着改善（， 95% CI [-0.68，0.12]）。就脱落率而言，虽然针刺组高于地衣芽孢杆菌加豆浆组（, 95% CI [0.24, 27.65]），洛哌丁胺组（, 95% CI [0.57, 2.15]）和马来酸曲美布汀组（， 95% CI [0.31, 4.53]），分别低于 dicetel 组（, 95% CI [0.56, 1.23]）并影响了总体趋势（， 95% CI [0.67，1.29]）。此外，在总症状评分方面，针灸比dicetel产生更显着的效果（， 95% CI [-1.42，-0.93]），IBS 生活质量（， 95% CI [1.94，2.80]），复发率（， 95% CI [0.28，0.66]）和 IBS 症状严重程度量表（， 95% CI [-1.04，-0.47]）。与迪塞特尔相比（， 95% CI [1.18，1.32]）和马来酸曲美布汀（， 95% CI [1.13, 1.61]），针灸在总效率上也表现出更有效。与dicetel组相比，针刺组发生的不良反应更多（， 95% CI [1.58, 89.07]）和洛哌丁胺组（, 95% CI [0.57, 33.97]），但大多数不良反应为轻度皮下出血。结论。针灸治疗可提高IBS-D或FD的临床疗效，且安全性较高，但上述结论尚需通过更高质量的证据进一步验证。