Clinical School of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
Department of Rehabilitation, Guangzhou First People's Hospital, Guangzhou, China.
Medicine (Baltimore). 2023 Feb 22;102(8):e33079. doi: 10.1097/MD.0000000000033079.
The aim of this study was to assess the efficiency and safety of acupuncture in core symptomatic improvement of children with autism spectrum disorder (ASD).
We searched the following databases: Cochrane Library, PubMed, Embase, Medline, China National Knowledge Infrastructure (CNKI), Wanfang, Chinese Science and Technology Periodical (VIP) and Chinese Biological Medicine (CBM), from 1 January 2012 to 25 September 2022. The Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), and Autism Treatment Evaluation Checklist (ATEC) were adopted as outcome indicators. Three reviewers independently assessed the risk of bias (ROB) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)assessment. Utilizing Review Manager (RevMan) 5.3 and Stata 12.0, data were analyzed.
A total of 38 trials were included, and 2862 participants participated in qualitative synthesis and meta-analysis. Only 1 trial was assessed as having a low ROB, and 37 trials were assessed as having an overall high ROB. The quality of evidence for most indicators were considered very low by the GRADE criteria. The results showed that acupuncture groups might have a higher clinical effective rate than nonacupuncture groups (relative risk [RR] = 1.33,95% confidence interval [CI] = 1.25-1.41; heterogeneity: x2=18.15, P = .64, I2 = 0%). Regarding changes in ABC scores, the acupuncture groups might exhibit greater decrease than nonacupuncture groups (MMD = -6.06, 95%CI = -7.25 to -4.87, P < .00001; heterogeneity: x2 =73.37, P = .03, I2 = 77%). In terms of changes in CARS score, acupuncture group may benefit more than nonacupuncture group (MMD = -3.93, 95%CI = 4.90 to -2.95, P < .00001; heterogeneity: x2=234.47, P < .00001, I2 = 90%). Additionally, in terms of ATEC score, acupuncture groups showed more benefit than nonacupuncture groups (MMD = -10.24, 95%CI = -13.09 to -7.38, P < .00001; heterogeneity: x2=45.74, P = .04, I2 = 85%). Both subgroup analysis and sensitivity analysis are existing heterogeneity. Only 1 RCT study involved adverse events with mild symptoms that did not interfere with treatment and evaluation.
Children with ASD may benefit from acupuncture because of its effectiveness and safety. Nevertheless, given the low quality of the evidence for the assessed outcomes and the high ROB of analyzed trials, the results should be regarded with caution.
本研究旨在评估针刺治疗儿童自闭症谱系障碍（ASD）核心症状改善的疗效和安全性。
我们检索了 Cochrane 图书馆、PubMed、Embase、Medline、中国知网（CNKI）、万方、中国科技期刊数据库（VIP）和中国生物医学文献数据库（CBM），检索时间为 2012 年 1 月 1 日至 2022 年 9 月 25 日。采用自闭症行为检查表（ABC）、儿童自闭症评定量表（CARS）和自闭症治疗评估检查表（ATEC）作为结局指标。三位审查员独立评估偏倚风险（ROB）和推荐评估、制定和评估分级（GRADE）评估。采用 Review Manager（RevMan）5.3 和 Stata 12.0 进行数据分析。
共纳入 38 项试验，2862 名参与者进行了定性综合和荟萃分析。只有 1 项试验被评估为低 ROB，37 项试验被评估为整体高 ROB。根据 GRADE 标准，大多数指标的证据质量均被认为非常低。结果显示，针刺组的临床有效率可能高于非针刺组（相对风险[RR] = 1.33，95%置信区间[CI] = 1.25-1.41；异质性：x2=18.15，P=.64，I2 = 0%）。在 ABC 评分变化方面，针刺组可能比非针刺组有更大的下降（MD = -6.06，95%CI = -7.25 至-4.87，P <.00001；异质性：x2=73.37，P=.03，I2 = 77%）。在 CARS 评分变化方面，针刺组可能比非针刺组获益更多（MD = -3.93，95%CI = 4.90 至-2.95，P <.00001；异质性：x2=234.47，P <.00001，I2 = 90%）。此外，在 ATEC 评分方面，针刺组比非针刺组获益更多（MD = -10.24，95%CI = -13.09 至-7.38，P <.00001；异质性：x2=45.74，P =.04，I2 = 85%）。亚组分析和敏感性分析均存在异质性。只有 1 项 RCT 研究涉及轻度症状的不良事件，这些不良事件不干扰治疗和评估。
儿童 ASD 可能从针刺中受益，因为其具有疗效和安全性。然而，鉴于评估结局的证据质量较低以及分析试验的 ROB 较高，结果应谨慎对待。
