Hung Caroline Yik-Fong, Wu Xin-Yin, Chung Vincent Chi-Ho, Tang Endy Chun-Hung, Wu Justin Che-Yuen, Lau Alexander Yuk-Lun
Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, 9/F, Lui Che Woo Clinical Sciences Building, Shatin, Hong Kong.
The Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong, 4L, 4/F, Day Treatment Block, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong.
Integr Med Res. 2019 Sep;8(3):145-159. doi: 10.1016/j.imr.2019.05.001. Epub 2019 May 15.
Acupuncture has been using as an alternative non-pharmacological therapy in the management of post stroke depression and cognitive impairment but its effectiveness and safety remain controversial. We conducted an overview of systematic reviews with meta-analyses to evaluate the evidence on the effect of acupuncture in the treatment of stroke with conventional medicine intervention. Systematic reviews summarized the treatment effects of acupuncture for post stroke cognitive impairment and post stroke depression were considered eligible. Methodological quality of included systematic reviews was assessed using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2). Four systematic reviews on post stroke cognitive impairment and ten systematic reviews on post stroke depression with good methodological quality were included. Meta-analyses revealed that acupuncture plus cognitive rehabilitation; and acupuncture or moxibustion plus cognitive rehabilitation, versus cognitive rehabilitation demonstrated statistically significant increase in Mini-Mental State Examination scores in compared to cognitive rehabilitation after 4 weeks treatment [Pooled weighted mean difference (WMD) = 3.14, 95% confidence interval (CI) = 2.06 to 4.21, I2 = 36%]; and (Pooled WMD = 3.22, 95% CI = 2.09 to 4.34, I2 = 0%). Furthermore, acupuncture versus antidepressant demonstrated statistically significant improve depression measured by increasing in 17-item Hamilton Depression Rating Scale in comparing to cognitive rehabilitation after 2 weeks treatment (Pooled WMD= -2.34, 95% CI= -3.46 to -1.22, I2 = 5%). Acupuncture usage was not associated with increased risk of adverse events. Acupuncture is safe and improves cognitive function and depressive disorder without obvious serious adverse events for post stroke patients.
针灸已被用作中风后抑郁和认知障碍管理的一种替代性非药物疗法，但其有效性和安全性仍存在争议。我们进行了一项系统评价及荟萃分析的概述，以评估针灸联合传统医学干预治疗中风效果的证据。纳入了总结针灸治疗中风后认知障碍和中风后抑郁治疗效果的系统评价。使用评估系统评价的测量工具2（AMSTAR 2）评估纳入系统评价的方法学质量。纳入了四项关于中风后认知障碍的系统评价和十项方法学质量良好的关于中风后抑郁的系统评价。荟萃分析显示，与认知康复相比，针灸联合认知康复；以及针灸或艾灸联合认知康复，在治疗4周后，简易精神状态检查表得分有统计学显著提高[合并加权平均差（WMD）=3.14，95%置信区间（CI）=2.06至4.21，I²=36%]；以及（合并WMD=3.22，95%CI=2.09至4.34，I²=0%）。此外，与抗抑郁药相比，针灸在治疗2周后，通过17项汉密尔顿抑郁量表测量显示抑郁有统计学显著改善（合并WMD=-2.34，95%CI=-3.46至-1.22，I²=5%）。针灸的使用与不良事件风险增加无关。针灸对中风后患者是安全的，可改善认知功能和抑郁障碍，且无明显严重不良事件。
