Hou Zhitao, Yu Xiaodi, Chen Jing, Brenner Jacob S, Sun Zhongren, Shang Hongcai
College of Basic Medical and Sciences, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, 150040, China.
Key Laboratory of Chinese Internal Medicine of the Ministry of Education, Dongzhimen Hospital Affiliated with Beijing University of Chinese Medicine, Beijing, 100700, China.
Heliyon. 2023 Aug 9;9(8):e18955. doi: 10.1016/j.heliyon.2023.e18955. eCollection 2023 Aug.
Vascular mild cognitive impairment (VMCI) is a common impairment caused by vascular factors. VMCI often occurs after stroke, and it is the main clinical manifestation of long-term disability. Many patients are treated with acupuncture in combination with other therapies. However, evidence regarding the effectiveness of this treatment regimen is lacking.
This meta-analysis aimed to evaluate the efficacy of acupuncture therapy for treating VMCI.
This systematic review was conducted in accordance with the preferred reporting and meta-analysis guidelines. The CNKI, Wanfang, VIP, CBM, Cochrane Library, PubMed and Embase databases were searched from inception to August 20, 2022. After two researchers independently screened the literature, they extracted the data and evaluated the risk of bias in the included studies. Revman 5.3 software was used for the meta-analysis.
Thirty-two randomized controlled trials (RCTs) were included. The overall effective rate of acupuncture for treating VMCI was 3.06, 95% CI [2.39, 3.91], (P < 0.05). Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Barthel Index and Activities of Daily Living (ADLs) scores significantly differed between the treatment and control groups, with weighted mean differences (WMDs) [95% CI] (P value) of 1.97 [1.44, 2.49] (P < 0.05), 2.02 [1.50, 2.54] (P < 0.05), 5.54 [3.81, 7.28] (P < 0.05), and 3.43 [2.53, 4.33] (P < 0.05), respectively. The overall effective rate of electroacupuncture (EA) for treating VMCI was better than that of the control group (RR = 2.25, 95% CI, [1.13, 4.50], P < 0.05). MoCA, MMSE, Barthel index and ADL scores differed significantly between the treatment and control groups, with WMDs [95% CI] (P value) of 1.79 [1.20, 2.38] (P < 0.05), 1.45 [0.87, 2.03] (P < 0.05), 5.78 [2.38, 9.18] (P < 0.05), and 3.15 [2.15, 4.15] (P < 0.05), respectively. Acupuncture alone and combined with drug therapy were thus superior to drug therapy alone for improving cognitive function. EA also has potential advantages.
Acupuncture combined with another therapy is better than other therapies alone, such as simple drug therapy, for treating VMCI. However, variations in study duration (4-12 weeks) limit us from drawing any definitive conclusions about long-term effects. Therefore, more RCTs with rigorous designs and reasonable treatment and follow-up durations are needed.
血管性轻度认知障碍（VMCI）是由血管因素引起的常见认知障碍。VMCI常发生于中风后，是长期残疾的主要临床表现。许多患者采用针灸联合其他疗法进行治疗。然而，关于这种治疗方案有效性的证据尚缺乏。
本荟萃分析旨在评估针灸疗法治疗VMCI的疗效。
本系统评价按照优先报告和荟萃分析指南进行。检索了中国知网、万方、维普、中国生物医学文献数据库、考克兰图书馆、PubMed和Embase数据库，检索时间从建库至2022年8月20日。两名研究人员独立筛选文献后，提取数据并评估纳入研究的偏倚风险。使用Revman 5.3软件进行荟萃分析。
纳入32项随机对照试验（RCT）。针灸治疗VMCI的总有效率为3.06，95%置信区间[2.39, 3.91]，（P < 0.05）。治疗组与对照组之间的蒙特利尔认知评估（MoCA）、简易精神状态检查表（MMSE）、巴氏指数和日常生活活动能力（ADL）评分有显著差异，加权平均差（WMD）[95%置信区间]（P值）分别为1.97 [1.44, 2.49]（P < 0.05）、2.02 [1.50, 2.54]（P < 0.05）、5.54 [3.81, 7.28]（P < 0.05）和3.43 [2.53, 4.33]（P < 0.05）。电针（EA）治疗VMCI的总有效率优于对照组（RR = 2.25，95%置信区间，[1.13, 4.50]，P < 0.05）。治疗组与对照组之间的MoCA评分、MMSE评分、巴氏指数和ADL评分有显著差异，WMD [95%置信区间]（P值）分别为1.79 [1.20, 2.38]（P < 0.05）、1.45 [0.87, 2.03]（P < 0.05）、5.78 [2.38, 9.18]（P < 0.05）和3.15 [2.15, 4.15]（P < 0.05）。因此，单纯针灸及针灸联合药物治疗在改善认知功能方面优于单纯药物治疗。EA也具有潜在优势。
针灸联合其他疗法治疗VMCI比单纯其他疗法（如单纯药物治疗）效果更好。然而，研究持续时间（4 - 12周）的差异限制了我们对长期疗效得出任何确定性结论。因此，需要更多设计严谨、治疗及随访时间合理的RCT。
