School of Public Health, Lanzhou University, Lanzhou 730000, China; Evidence Based Social Science Research Center, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.
Chinese Medicine Faculty of Hong Kong Baptist University, Hong Kong.
Complement Ther Med. 2020 May;50:102383. doi: 10.1016/j.ctim.2020.102383. Epub 2020 Mar 12.
Acupuncture is an alternative therapy for Parkinson's disease (PD), but its efficacy and safety are controversial. This overview aimed to summarize the existing evidence from systematic reviews (SRs) and meta-analyses (MAs) in order to assess the effectiveness of acupuncture as a treatment for PD.
Seven electronic databases were searched from their inception until July 2019. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) and Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklists were used to assess evidence quality and methodological quality, respectively. The outcomes of study were calculated using mean differences (MDs) and risk ratios (RRs) with 95 % confidence intervals (CIs). A meta-analysis was performed using RevMan 5.3 software.
A total of 12 SRs/MAs were included. All 12 SRs/MAs had more than one critical weakness in AMSTAR 2 and were considered of critically low methodological quality. The quality of evidence was unsatisfactory according to the GRADE checklist. Meta-analyses showed that acupuncture combined with drug for the treatment of PD can significantly improve the total effectiveness rate compared with drug alone (RR = 1.25, 95 % CI 1.16-1.34, P < 0.001). It was also found that acupuncture combined with drug significantly improved the UPDRS I-IV total summed scores (WMD=-6.18, 95 % CI -10.32 to -2.04, P < 0.001) and Webster scores (WMD=-4.20, 95 % CI -7.59 to -0.81, P < 0.001).
Acupuncture might improve the UPDRS score, Webster score, and total effective rate in treatment of PD. It might be a safe and useful adjunctive treatment for patients with PD. However, we should interpret the findings of these reviews with caution, considering the overall limited methodological and reporting quality.
针灸是治疗帕金森病（PD）的一种替代疗法，但疗效和安全性存在争议。本综述旨在总结系统评价（SR）和荟萃分析（MA）的现有证据，以评估针灸治疗 PD 的有效性。
从建库起至 2019 年 7 月，检索了 7 个电子数据库。使用推荐、评估、制定和评估（GRADE）和评估多个系统评价 2（AMSTAR2）清单分别评估证据质量和方法学质量。使用均数差（MD）和风险比（RR）及其 95%置信区间（CI）计算研究结果。使用 RevMan 5.3 软件进行荟萃分析。
共纳入 12 项 SR/MA。所有 12 项 SR/MA 在 AMSTAR 2 中均存在一个以上的关键缺陷，被认为方法学质量极低。根据 GRADE 清单，证据质量不佳。荟萃分析显示，与单独用药相比，针灸联合药物治疗 PD 可显著提高总有效率（RR=1.25，95%CI 1.16-1.34，P<0.001）。还发现，与单独用药相比，针灸联合药物治疗还可显著改善 UPDRS I-IV 总分（WMD=-6.18，95%CI-10.32 至-2.04，P<0.001）和 Webster 评分（WMD=-4.20，95%CI-7.59 至-0.81，P<0.001）。
针灸可能改善 PD 患者的 UPDRS 评分、Webster 评分和总有效率，可能是 PD 患者安全有效的辅助治疗方法。然而，考虑到整体方法学和报告质量有限，我们应该谨慎解释这些综述的结果。
