Liu Hongjie, Chen Lingxiu, Zhang Zhe, Geng Guozhu, Chen Wenjun, Dong Hanqiu, Chen Liang, Zhan Sha, Li Tianhao
College of Traditional Chinese Medicine, Jinan University, Guangzhou, China.
Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
Acupunct Med. 2017 Dec;35(6):404-412. doi: 10.1136/acupmed-2016-011342. Epub 2017 Nov 27.
To evaluate the effectiveness and safety of acupuncture combined with Madopar for the treatment of Parkinson's disease (PD), compared to the use of Madopar alone.
A systematic search was carried out for randomised controlled trials (RCTs) of acupuncture and Madopar for the treatment of PD published between April 1995 and April 2015. The primary outcome was total effectiveness rate and secondary outcomes included Unified Parkinson's Disease Rating Scale (UPDRS) scores. Data were pooled and analysed with RevMan 5.3. Results were expressed as relative ratio (RR) with 95% confidence interval (CIs).
Finally, 11 RCTs with 831 subjects were included. Meta-analyses showed that acupuncture combined with Madopar for the treatment of PD can significantly improve the clinical effectiveness compared with Madopar alone (RR=1.28, 95% CI 1.18 to 1.38, P<0.001). It was also found that acupuncture combined with Madopar significantly improved the UPDRS II (SMD=-1.00, 95% CI -1.71 to -0.29, P=0.006) and UPDRS I-IV total summed scores (SMD=-1.15, 95% CI -1.63 to -0.67, P<0.001) but not UPDRS I (SMD=-0.37, 95% CI -0.77 to 0.02, P=0.06), UPDRS III (SMD=-0.93, 95% CI -2.28 to 0.41, P=0.17) or UPDRS IV (SMD=-0.78, 95% CI -2.24 to 0.68, P=0.30) scores. Accordingly, acupuncture combined with Madopar appeared to have a positive effect on activities of daily life and the general condition of patients with PD, but was not better than Madopar alone for the treatment of mental activity, behaviour, mood and motor disability. In the safety evaluation, it was found that acupuncture combined with Madopar was associated with significantly fewer adverse effects including gastrointestinal reactions (RR=0.38, 95% CI 0.23 to 0.65, P<0.001), on-off phenomena (RR=0.27, 95% CI 0.11 to 0.66, P=0.004) and mental disorders (RR=0.24, 95% CI 0.06 to 0.92, P=0.04) but did not significantly reduce dyskinesia (RR=0.64, 95% CI 0.35 to 1.16, P=0.14).
Acupuncture combined with Madopar appears, to some extent, to improve clinical effectiveness and safety in the treatment of PD, compared with Madopar alone. This conclusion must be considered cautiously, given the quality of most of the studies included was low. Therefore, more high-quality, multicentre, prospective, RCTs with large sample sizes are needed to further clarify the effect of acupuncture combined with Madopar for PD.
评估针刺联合美多芭治疗帕金森病（PD）的有效性和安全性，并与单纯使用美多芭进行比较。
对1995年4月至2015年4月间发表的关于针刺与美多芭治疗PD的随机对照试验（RCT）进行系统检索。主要结局为总有效率，次要结局包括统一帕金森病评定量表（UPDRS）评分。数据采用RevMan 5.3进行汇总和分析。结果以相对比值（RR）及95%置信区间（CIs）表示。
最终纳入11项RCT，共831例受试者。荟萃分析显示，与单纯使用美多芭相比，针刺联合美多芭治疗PD可显著提高临床疗效（RR = 1.28，95% CI 1.18至1.38，P < 0.001）。还发现针刺联合美多芭可显著改善UPDRS II（标准化均数差[SMD] = -1.00，95% CI -1.71至 -0.29，P = 0.006）及UPDRS I - IV总分（SMD = -1.15，95% CI -1.63至 -0.67，P < 0.001），但对UPDRS I（SMD = -0.37，95% CI -0.77至0.02，P = 0.06）、UPDRS III（SMD = -0.93，95% CI -2.28至0.41，P = 0.17）或UPDRS IV（SMD = -0.78，95% CI -2.24至0.68，P = 0.30）评分改善不明显。因此，针刺联合美多芭似乎对PD患者的日常生活活动及总体状况有积极影响，但在治疗精神活动、行为、情绪及运动功能障碍方面并不优于单纯使用美多芭。在安全性评估中，发现针刺联合美多芭的不良反应明显较少，包括胃肠道反应（RR = 0.38，95% CI 0.23至0.65，P < 0.001）、开关现象（RR = 0.27，95% CI 0.11至0.66，P = 0.004）及精神障碍（RR = 0.24，95% CI 0.06至0.92，P = 0.04），但对异动症的减少无显著作用（RR = 0.64，95% CI 0.35至1.16，P = 0.14）。
与单纯使用美多芭相比，针刺联合美多芭在一定程度上似乎可提高PD治疗的临床疗效及安全性。鉴于纳入的大多数研究质量较低，该结论必须谨慎考虑。因此，需要更多高质量、多中心、前瞻性、大样本量的RCT来进一步阐明针刺联合美多芭治疗PD的效果。
