Yin Zihan, Li Yaqin, Jiang Cheng, Xia Manze, Chen Zhenghong, Zhang Xinyue, Zhao Ling, Liang Fanrong
School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China.
Front Neurol. 2023 Jan 6;13:1091125. doi: 10.3389/fneur.2022.1091125. eCollection 2022.
There is insufficient evidence to support the use of acupuncture for mild cognitive impairment (MCI), and there is no consensus on its efficacy. This review aimed to determine the acupuncture effect in patients with MCI.
Relevant and potentially eligible randomized controlled trials (RCTs) of acupuncture for MCI were obtained from four Chinese databases, four English databases, and additional resources up to 1 August 2022. The primary outcome was the improvement in overall cognitive function (OCF). Secondary outcomes were improved memory function (MF) and activities of daily living (ADLs). The revised Cochrane collaboration risk of bias (ROB) assessment tool (ROB 2.0) was applied to evaluate their methodological quality. The Review Manager software v 5.4 was used for analyses. Trial sequential analysis (TSA) 0.9.5.10 β software was used to estimate the required sample size and test the reliability of the pooled outcome. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.
This meta-analysis included 11 RCTs with a total of 602 patients. The methodological quality of all trials was moderate. Low-quality evidence showed that acupuncture significantly improved OCF (Mini-Mental State Examination (MMSE): mean difference (MD) = 1.22, 95% confidence interval (CI): 0.78-1.66; the Montreal Cognitive Assessment Scale (MoCA): MD = 1.22, 95% CI: 0.47-1.97). In subgroup analyses, it was revealed that acupuncture significantly increased OCF in patients with MCI when compared to conventional medicine (CM) and sham acupuncture (SA). TSA's findings indicated that the evidence of improving OCF with acupuncture for patients with MCI was conclusive. Meanwhile, there is no statistical difference in the improvement of MF and ADL between acupuncture and CM. TSA showed that the evidence of improving MF and ADL for patients who had MCI and received acupuncture was inconclusive. The shreds of evidence of improving MF and ADL were ranked from low to critically low.
Acupuncture appears to be an effective clinical application method for improving OCF in patients with MCI. However, due to low-quality evidence, more relevant and high-quality research is needed in this field.
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021291284, PROSPERO, No. CRD42021291284.
目前尚无充分证据支持将针灸用于治疗轻度认知障碍（MCI），其疗效也未达成共识。本综述旨在确定针灸对MCI患者的治疗效果。
从四个中文数据库、四个英文数据库以及截至2022年8月1日的其他资源中获取有关针灸治疗MCI的相关且可能符合条件的随机对照试验（RCT）。主要结局是整体认知功能（OCF）的改善。次要结局是记忆功能（MF）和日常生活活动能力（ADL）的改善。应用修订后的Cochrane协作偏倚风险（ROB）评估工具（ROB 2.0）来评估其方法学质量。使用Review Manager软件v 5.4进行分析。采用试验序贯分析（TSA）0.9.5.10 β软件来估计所需样本量并检验合并结局的可靠性。使用推荐分级的评估、制定与评价（GRADE）工具评估证据质量。
本荟萃分析纳入了11项RCT，共602例患者。所有试验的方法学质量为中等。低质量证据表明，针灸显著改善了OCF（简易精神状态检查表（MMSE）：平均差（MD）=1.22，95%置信区间（CI）：0.78-1.66；蒙特利尔认知评估量表（MoCA）：MD = 1.22，95%CI：0.47-1.97）。在亚组分析中发现，与传统医学（CM）和假针灸（SA）相比，针灸显著提高了MCI患者的OCF。TSA的结果表明，针灸改善MCI患者OCF的证据是确凿的。同时，针灸与CM在改善MF和ADL方面无统计学差异。TSA表明，针灸改善MCI患者MF和ADL的证据尚无定论。改善MF和ADL的证据质量等级从低到极低。
针灸似乎是改善MCI患者OCF的一种有效临床应用方法。然而，由于证据质量较低，该领域需要更多相关的高质量研究。
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021291284，PROSPERO，编号CRD42021291284。
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