Li Li, Zhang Hong, Meng Shu-qing, Qian Hai-zhou
Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China.
PLoS One. 2014 Dec 1;9(12):e114057. doi: 10.1371/journal.pone.0114057. eCollection 2014.
Ischemic stroke is the second most common cause of death and the primary cause of disability throughout the world. Acupuncture is frequently advocated as an adjunct treatment during stroke rehabilitation. The aim of this study was to update the clinical efficacy and safety of acupuncture for cerebral infarction.
Randomized controlled trials (RCT) on acupuncture treating cerebral infarction were searched from the following databases: PubMed, EMBASE, Cochrane Library, CNKI, CMB and VIP from inception to October 2013. The data of RCTs meeting the inclusive criteria were extracted according to Cochrane methods. The meta-analyses were conducted using Rev Man 5.0 software.
A total of 25 trials involving 2224 patients were included. The results of this meta-analysis showed that the groups receiving acupuncture (observation group) were superior to the comparison groups (control group), with significant differences in the Clinical Efficacy Rates [OR = 4.04, 95%CI (2.93, 5.57), P<0.001], Fugl-Meyer Assessment [MD = 11.22, 95%CI (7.62, 14.82), P<0.001], Barthel Index Score [MD = 12.84, 95%CI (9.85, 15.82), P<0.001], and Neurological Deficit Score [MD = -2.71, 95% CI (-3.84, -1.94), P<0.001]. Three trials reported minor adverse events.
Current evidence provisionally demonstrates that acupuncture treatment is superior to either non-acupuncture or conventional therapy for cerebral infarction. Despite this conclusion, given the often low quality of the available trials, further large scale RCTs of better quality are still needed.
缺血性中风是全球第二大常见死因及残疾的主要原因。针灸常被推荐作为中风康复期间的辅助治疗方法。本研究旨在更新针灸治疗脑梗死的临床疗效及安全性。
从以下数据库检索针灸治疗脑梗死的随机对照试验(RCT):PubMed、EMBASE、Cochrane图书馆、中国知网、中国生物医学文献数据库和维普资讯,检索时间从建库至2013年10月。根据Cochrane方法提取符合纳入标准的RCT数据。使用Rev Man 5.0软件进行荟萃分析。
共纳入25项试验,涉及2224例患者。该荟萃分析结果显示,接受针灸治疗的组(观察组)优于对照组,在临床有效率[比值比(OR)=4.04,95%置信区间(CI)(2.93,5.57),P<0.001]、Fugl-Meyer评估[均数差(MD)=11.22,95%CI(7.62,14.82),P<0.001]、Barthel指数评分[MD=12.84,95%CI(9.85,15.82),P<0.001]及神经功能缺损评分[MD=-2.71,95%CI(-3.84,-1.94),P<0.001]方面存在显著差异。三项试验报告了轻微不良事件。
目前证据初步表明,针灸治疗脑梗死优于非针灸治疗或传统疗法。尽管有此结论,但鉴于现有试验质量往往较低,仍需要进一步开展更高质量的大规模RCT。