Wu H M, Tang J L, Lin X P, Lau J, Leung P C, Woo J, Li Y P
West China Hospital, Si Chuan University, Department of Geriatrics, Chengdu, Si Chuan, China 610041.
Cochrane Database Syst Rev. 2006 Jul 19(3):CD004131. doi: 10.1002/14651858.CD004131.pub2.
Stroke is the third leading cause of death in Western society; in China it is the second most common cause of death in cities and the third in rural areas. It is also a main cause of adult disability and dependency. Acupuncture for stroke has been used in China for hundreds of years and is increasingly practiced in some Western countries.
To assess the efficacy and safety of acupuncture for patients with stroke in the subacute or chronic stage.
We searched the Cochrane Stroke Group Trials Register (November 2005), the Cochrane Complementary Medicine Field Trials Register (November 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to November 2005), EMBASE (1980 to November 2005), CINAHL (1982 to November 2005), AMED (1985 to November 2005), the Chinese Stroke Trials Register (November 2005), the Chinese Acupuncture Trials Register (November 2005), the Chinese Biological Medicine Database (1977 to November 2005), the National Center for Complementary and Alternative Medicine Register (November 2005), and the National Institute of Health Clinical Trials Database (November 2005). We handsearched four Chinese journals and checked reference lists of all papers identified for further trials.
Truly randomised unconfounded clinical trials among patients with ischemic or hemorrhagic stroke, in the subacute or chronic stage, which compared acupuncture involving needling with either placebo acupuncture, sham acupuncture or no acupuncture.
Two review authors independently selected trials for inclusion, assessed quality, extracted and cross-checked the data.
Five trials (368 patients) met the inclusion criteria. Methodological quality was considered inadequate in all trials. Although the overall estimate from four trials suggested the odds of improvement in global neurological deficit was higher in the acupuncture group compared with the control group (odds ratio (OR) 6.55, 95% confidence interval (CI) 1.89 to 22.76), this estimate may not be reliable since there was substantial heterogeneity (I(2 )= 68%). One trial showed no significant improvement of motor function between the real acupuncture group and the sham acupuncture group (OR 9.00, 95% CI 0.40 to 203.30), but the confidence interval was wide and included clinically significant effects in both directions. No data on death, dependency, institutional care, change of neurological deficit score, quality of life or adverse events were available.
AUTHORS' CONCLUSIONS: Currently there is no clear evidence on the effects of acupuncture on subacute or chronic stroke. Large, methodologically-sound trials are required.
中风是西方社会第三大死因；在中国，它是城市中第二大常见死因，在农村地区则是第三大死因。它也是导致成年人残疾和生活不能自理的主要原因。针灸治疗中风在中国已应用数百年，并且在一些西方国家也越来越多地被采用。
评估针灸对亚急性期或慢性期中风患者的疗效和安全性。
我们检索了Cochrane中风组试验注册库（2005年11月）、Cochrane补充医学领域试验注册库（2005年11月）、Cochrane对照试验中心注册库（《Cochrane图书馆》2005年第3期）、医学期刊数据库（1966年至2005年11月）、荷兰医学文摘数据库（1980年至2005年11月）、护理学与健康领域数据库（1982年至2005年11月）、澳大利亚医学数据库（1985年至2005年11月）、中国中风试验注册库（2005年11月）、中国针灸试验注册库（2005年11月）、中国生物医学数据库（1977年至2005年11月）、美国国立补充与替代医学中心注册库（2005年11月）以及美国国立卫生研究院临床试验数据库（2005年11月）。我们手工检索了四种中文期刊，并查阅了所有已识别论文的参考文献列表以寻找进一步的试验。
针对亚急性期或慢性期缺血性或出血性中风患者进行的真正随机、无混淆因素的临床试验，该试验将涉及针刺的针灸与安慰剂针灸、假针灸或不进行针灸进行比较。
两位综述作者独立选择纳入试验、评估质量、提取并交叉核对数据。
五项试验（368例患者）符合纳入标准。所有试验的方法学质量均被认为不充分。尽管四项试验的总体估计表明，与对照组相比，针灸组整体神经功能缺损改善的几率更高（优势比（OR）6.55，95%置信区间（CI）1.89至22.76），但由于存在显著异质性（I² = 68%），该估计可能不可靠。一项试验显示，真针灸组与假针灸组之间的运动功能无显著改善（OR 9.00，95% CI 0.40至203.30），但置信区间较宽，且在两个方向上都包含了具有临床意义的效应。没有关于死亡、生活不能自理、机构护理、神经功能缺损评分变化、生活质量或不良事件的数据。
目前尚无明确证据表明针灸对亚急性期或慢性期中风有效果。需要进行大规模、方法学严谨的试验。
