Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, GuangZhou, China.
Guangzhou University of Traditional Chinese Medicine, GuangZhou, China.
PLoS One. 2021 Apr 9;16(4):e0249313. doi: 10.1371/journal.pone.0249313. eCollection 2021.
Post-stroke spasm is currently a complex clinical problem that remains to be resolved. Due to its excellent efficacy and few side effects, clinicians have used fire acupuncture to treat post-stroke spasticity in China.
The purpose of this study was to evaluate the clinical efficacy of fire acupuncture compared with conventional acupuncture to treat post-stroke spasms and provide a detailed summary of the commonly used acupoints.
Eight databases (MEDLINE/PubMed, Web of Science, the Cochrane database, EMBASE, CBM, CNKI, WanFang, and VIP) were searched for randomized controlled trials (RCTs) published from database inception through August 30, 2020. RCTs that compared fire acupuncture with conventional acupuncture as a treatment intervention for patients with spasticity after stroke were included. Revman 5.3 software was used to calculate risk ratios (RR) and standard mean differences (SMD) with 95% confidence intervals (CI). Methodological evaluation or critical appraisal of the included articles was assessed using RoB-2.
Sixteen studies with a total of 1,118 patients were included. Although according to the standards of the Rob 2.0 tool, most studies are considered to have some problems. Comprehensive analysis of the results revealed a consistent trend indicating several advantages of using fire needles compared to conventional acupuncture in treating post-stroke spasms, including the effective rate, recovery rate, and improvement of multiple scales represented by MAS. Concerning secondary outcomes, using the scales of FMA, BI, or NDS in this random model meta-analysis, fire acupuncture exhibited better performance compared to acupuncture [SMD = 2.27, 95%CI [1.40,3.13 (random-effects model) ], [SMD = 1.46,95% CI [1.03,1.90 (random-effects model)], and [SMD = 0.90, 95%CI [0.44,1.35 (random-effects model)], respectively, with moderately high heterogeneity. When the effective rate was used as an outcome in the subgroup analysis, fire needles performed better than conventional acupuncture with respect to damage to the upper or lower limbs, and the thickness and depth of acupuncture. When the modified Ashworth scale (MAS) was used as the outcome, and the damage occurred in the lower extremity, the acupuncture depth exceeded 15mm, or the duration of stroke was longer than six months, the fire needles did not perform better than conventional acupuncture, [SMD = 0.01, 95%CI [-0.47,0.48 (fix-effects model)], [SMD = 0.21 [-0.51,0.93(random-effects model)], and [SMD = 0.76, 95%CI [-0.08,1.60 (random-effects model)], respectively. The acupoints identified with the highest frequencies in this study were Yang-meridian, including LI11-Quchi (nine times), LI4-Hegu (seven times), and ST36-Zusanli (five times). Moreover, no serious adverse effects were reported in any of the studies included in this analysis.
Despite several limitations, this was the first meta-analysis to focus on the treatment of post-stroke spasticity using fire needle acupuncture compared with conventional acupuncture. Our results confirmed that fire needles could provide a better clinical effect than conventional acupuncture, which will help standardize fire needle treatment strategies for post-stroke spasms.
脑卒中后痉挛目前仍是一个复杂的临床问题,有待解决。由于疗效确切、副作用少,临床医生已在中国使用火针治疗脑卒中后痉挛。
本研究旨在评价火针与常规针刺治疗脑卒中后痉挛的临床疗效,并对常用穴位进行详细总结。
检索 MEDLINE/PubMed、Web of Science、Cochrane 数据库、EMBASE、CBM、CNKI、WanFang 和 VIP 自建库至 2020 年 8 月 30 日的随机对照试验(RCT)。纳入比较火针与常规针刺治疗脑卒中后痉挛患者的 RCT。采用 Revman 5.3 软件计算风险比(RR)和标准均数差(SMD)及其 95%置信区间(CI)。采用 RoB-2 工具对纳入文献进行方法学评价或质量评估。
共纳入 16 项研究,总计 1118 例患者。虽然根据 Rob 2.0 工具的标准,大多数研究被认为存在一些问题,但综合分析结果表明,火针在治疗脑卒中后痉挛方面具有几个优势,包括有效率、恢复率和 MAS 等多个量表的改善。对于次要结局,在本随机模型荟萃分析中,使用 FMA、BI 或 NDS 量表,火针的表现优于针刺[SMD=2.27,95%CI(1.40,3.13,随机效应模型)]、[SMD=1.46,95%CI(1.03,1.90,随机效应模型)]和[SMD=0.90,95%CI(0.44,1.35,随机效应模型)],存在中度高度异质性。当有效率作为亚组分析的结局时,火针在治疗上肢或下肢、针刺深度和厚度方面优于常规针刺。当改良 Ashworth 量表(MAS)作为结局,且损伤发生在下肢、针刺深度超过 15mm 或中风持续时间超过 6 个月时,火针并不优于常规针刺[SMD=0.01,95%CI(-0.47,0.48,固定效应模型)]、[SMD=0.21,95%CI(-0.51,0.93,随机效应模型)]和[SMD=0.76,95%CI(-0.08,1.60,随机效应模型)]。本研究中出现频率最高的穴位是阳经,包括 LI11-Quchi(9 次)、LI4-Hegu(7 次)和 ST36-Zusanli(5 次)。此外,本分析纳入的所有研究均未报告严重不良事件。
尽管存在一些局限性,但这是首次专门针对火针与常规针刺治疗脑卒中后痉挛的疗效进行的荟萃分析。我们的结果证实,火针可以提供比常规针刺更好的临床效果,这将有助于规范脑卒中后痉挛的火针治疗策略。