The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China; Ying Lv's Renowned Expert Inheritance Studio, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China; Ying Lv's Renowned Expert Inheritance Studio, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
Complement Ther Med. 2023 Sep;76:102968. doi: 10.1016/j.ctim.2023.102968. Epub 2023 Aug 8.
Attention deficit hyperactivity disorder (ADHD) is one of the most common neurological and mental developmental disorders in children. Published systematic reviews (SRs) and meta-analyses (MAs) concerning the use of acupuncture for ADHD have compared the efficacy of acupuncture treatment to that of drug therapies. However, the quality of these articles has not been evaluated and the evidence varies widely.
To summarize and assess the efficacy of acupuncture for ADHD based on existing SRs and MAs.
A systematic search of the literature was conducted from inception until September 16 2021, using seven electronic databases. The AMSTAR-2 tool was used to evaluate the quality of SRs and MAs, and the GRADE system was used to assess the quality of evidence.
There are a total of five SRs and MAs included in this overview. Using the AMSTAR-2, three articles were rated as having 'Low' quality, while two were rated as having of 'Critically Low' quality. The GRADE system was used to measure the quality of evidence for ten outcomes (five response rate outcomes, three Conners' Index of Hyperactivity (CIH) score outcomes, one Conners' rating scale score outcome, and one Chinese medicine syndrome outcome) across the five included MAs. Four of the ten outcomes demonstrated 'moderate' quality, four demonstrated 'low' quality, and two demonstrated 'very low' quality. The risk of bias and inconsistency accounted for most downgrading factors in the included reviews.
It is still debatable whether acupuncture is efficacious in improving the CIH score and the Response rate. Considering the heterogeneity of clinical trials and the fact that this study did not search and evaluate the relevant data of each randomized controlled trial, large-sample and high-quality randomized controlled trials are still needed to draw reliable conclusions regarding acupuncture's role in treating ADHD. Due to the poor quality of existing available evidence, little inference can be drawn from the included studies.
注意缺陷多动障碍（ADHD）是儿童中最常见的神经和精神发育障碍之一。已发表的关于针刺治疗 ADHD 的系统评价（SR）和荟萃分析（MA）比较了针刺治疗与药物治疗的疗效。然而，这些文章的质量尚未得到评估，证据差异很大。
根据现有 SR 和 MA 总结和评估针刺治疗 ADHD 的疗效。
从建库开始到 2021 年 9 月 16 日，系统地检索了七项电子数据库中的文献。采用 AMSTAR-2 工具评价 SR 和 MA 的质量，采用 GRADE 系统评价证据质量。
本综述共纳入 5 项 SR 和 MA。采用 AMSTAR-2 评价，其中 3 项文章质量为“低”，2 项为“极低”。GRADE 系统用于评价 5 项 MA 中的 10 项结局（5 项应答率结局、3 项 Conners 多动指数（CIH）评分结局、1 项 Conners 评定量表评分结局和 1 项中医证候结局）的证据质量。10 项结局中的 4 项为“中”质量，4 项为“低”质量，2 项为“极低”质量。纳入研究的偏倚风险和不一致性是导致降级的主要因素。
针刺是否能有效提高 CIH 评分和应答率仍存在争议。考虑到临床试验的异质性，以及本研究未检索和评价每个随机对照试验的相关数据，仍需要大样本、高质量的随机对照试验来得出关于针刺治疗 ADHD 的可靠结论。由于现有可用证据质量较差，从纳入的研究中无法得出太多推论。
