针刺治疗帕金森病吞咽困难的系统评价与Meta分析

A systematic review and meta-analysis of acupuncture in Parkinson's disease with dysphagia.

作者信息

Wu Jing, Wang Yi, Wang Xueyan, Xie Yujia, Li Weihong

机构信息

Basic Medical School of Chengdu University of Traditional Chinese Medicine, Chengdu, China.

Clinical Medical School of Chengdu University of Traditional Chinese Medicine, Chengdu, China.

出版信息

Front Neurol. 2023 May 26;14:1099012. doi: 10.3389/fneur.2023.1099012. eCollection 2023.

DOI:10.3389/fneur.2023.1099012

PMID:37305760

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10251408/

Abstract

OBJECTIVE

The systematic review and meta-analysis aimed to comprehensively evaluate acupuncture's efficacy and safety in treating dysphagia in Parkinson's disease (PD).

METHODS

We searched PubMed, Cochrane Library, Embase, Web of Science, China Knowledge Infrastructure (CNKI), China Science Journal Database (VIP), Wan-fang Database, and the China Biomedical Literature Service System (CBM) for randomized controlled trials (RCTs) comparing the efficacy of acupuncture alone or in combination with control treatment in improving dysphagia by October 2022. The degree of dysphagia was the primary outcome indicator, with secondary outcomes including serum albumin (ALB) and hemoglobin (Hb) levels, the incidence of pneumonia, and adverse events. Two investigators independently extracted information according to the inclusion and exclusion criteria. Data synthesis was calculated by RevMan (V.5.4.1) software.

RESULTS

This study included ten randomized controlled trials with 724 patients. Most RCTs have a high or uncertain risk of bias due to the lack of a blinded design. Meta-analysis showed that acupuncture combined with control treatment was superior to control treatment alone in improving Videofluoroscopic Swallowing Study (VFSS) scores (MD: 1.48; 95% CI: 1.16, 1.81; < 0.00001) and reducing Standardized Swallowing Assessment (SSA) scores (MD: -3.08; 95% CI: -4.01, -2.15; < 0.00001). Acupuncture combined with control therapy has a more significant benefit in improving the clinical efficiency of dysphagia in PD (RR: 1.40; 95%CI: 1.25, 1.58; < 0.00001). Compared to the control group without acupuncture, acupuncture improved the nutritional status of patients and increased their serum ALB (MD: 3.38, 95%CI: 1.83, 4.92, < 0.00001) and Hb levels (MD: 7.66; 95%CI: 5.57, 9.75; < 0.00001). Three RCTs reported that the rate of pulmonary infections in the acupuncture group was lower than without acupuncture intervention (RR: 0.29, 95% CI: 0.14, 0.63; = 0.001).

CONCLUSION

Acupuncture could be recommended as an adjunctive treatment for dysphagia in PD. However, due to the high risk of bias in the included studies, more high-quality evidence is needed to confirm the efficacy and safety of acupuncture for dysphagia in PD.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022370221.

摘要

目的

本系统评价和荟萃分析旨在全面评估针灸治疗帕金森病（PD）吞咽困难的疗效和安全性。

方法

我们检索了PubMed、Cochrane图书馆、Embase、科学引文索引（Web of Science）、中国知网（CNKI）、维普中文科技期刊数据库（VIP）、万方数据库和中国生物医学文献服务系统（CBM），以查找截至2022年10月比较单独针灸或针灸联合对照治疗改善吞咽困难疗效的随机对照试验（RCT）。吞咽困难程度是主要结局指标，次要结局包括血清白蛋白（ALB）和血红蛋白（Hb）水平、肺炎发生率及不良事件。两名研究者根据纳入和排除标准独立提取信息。采用RevMan（V.5.4.1）软件进行数据合成。

结果

本研究纳入10项随机对照试验，共724例患者。由于缺乏盲法设计，大多数RCT存在高偏倚风险或偏倚风险不确定。荟萃分析显示，针灸联合对照治疗在改善电视荧光吞咽造影检查（VFSS）评分（MD：1.48；95%CI：1.16，1.81；P<0.00001）和降低标准化吞咽评估（SSA）评分（MD：-3.08；95%CI：-4.01，-2.15；P<0.00001）方面优于单纯对照治疗。针灸联合对照治疗在提高PD吞咽困难临床疗效方面有更显著益处（RR：1.40；95%CI：1.25，1.58；P<0.00001）。与未接受针灸治疗的对照组相比，针灸改善了患者的营养状况，提高了血清ALB（MD：3.38，95%CI：1.83，4.92，P<0.00001）和Hb水平（MD：7.66；95%CI：5.57，9.75；P<0.00001）。3项RCT报告称，针灸组肺部感染发生率低于未进行针灸干预的组（RR：0.29，95%CI：0.14，0.63；P=0.001）。