Liu Yang, Zhao Lu, Chen Fuyan, Li Xingping, Han Jiangqin, Sun Xiaowei, Bian Mingtong
Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
Front Neurol. 2023 Aug 10;14:1218095. doi: 10.3389/fneur.2023.1218095. eCollection 2023.
Acupuncture therapy has been widely used to treat post-stroke cognitive impairment (PSCI). However, acupuncture therapy includes multiple forms. Which acupuncture therapy provides the best treatment outcome for patients with PSCI remains controversial.
We aimed to compare and evaluate the efficacy and safety of different acupuncture-related therapies for PSCI in an attempt to identify the best acupuncture therapies that can improve cognitive function and self-care in daily life for patients with PSCI, and bring new insights to clinical practice.
We searched eight databases including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China Biomedical Literature Database (CBM), China Science and Technology Journal (VIP) database, China National Knowledge Infrastructure (CNKI) database, and Wan fang database to find randomized controlled trials (RCTs) of acupuncture-related therapies for PSCI from the inception of the database to January 2023. Two researchers independently assessed the risk of bias in the included studies and extracted the study data. Pairwise meta-analyzes for direct comparisons were performed using Rev. Man 5.4 software. Bayesian network meta-analysis (NMA) was performed using STATA 17.0 and R4.2.4 software. The quality of evidence from the included studies was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Adverse effects (AEs) associated with acupuncture therapy were collected by reading the full text of the included studies to assess the safety of acupuncture therapy.
A total of 62 RCTs (3 three-arm trials and 59 two-arm trials) involving 5,073 participants were included in this study. In the paired meta-analysis, most acupuncture-related therapies had a positive effect on cognitive function and self-care of daily living in patients with PSCI compared with cognitive training. Bayesian NMA results suggested that ophthalmic acupuncture plus cognitive training (79.7%) was the best acupuncture therapy for improving MMSE scores, with scalp acupuncture plus cognitive training ranking as the second (73.7%). The MoCA results suggested that warm acupuncture plus cognitive training (86.5%) was the best acupuncture therapy. In terms of improvement in daily living self-care, scalp acupuncture plus body acupuncture (87.5%) was the best acupuncture therapy for improving MBI scores. The most common minor AEs included subcutaneous hematoma, dizziness, sleepiness, and pallor.
According to our Bayesian NMA results, ophthalmic acupuncture plus cognitive training and warm acupuncture plus cognitive training were the most effective acupuncture treatments for improving cognitive function, while scalp acupuncture plus body acupuncture was the best acupuncture treatment for improving the performance of self-care in daily life in patients with PSCI. No serious adverse effects were found in the included studies, and acupuncture treatment appears to be safe and reliable. However, due to the low methodological quality of the included studies, our findings need to be treated with caution. High-quality studies are urgently needed to validate our findings.
https://www.crd.york.ac.uk/prospero/#recordDetails, identifier: CRD42022378353.
针刺疗法已被广泛用于治疗中风后认知障碍（PSCI）。然而，针刺疗法包含多种形式。哪种针刺疗法对PSCI患者提供最佳治疗效果仍存在争议。
我们旨在比较和评估不同针刺相关疗法治疗PSCI的疗效和安全性，试图确定能改善PSCI患者认知功能和日常生活自理能力的最佳针刺疗法，并为临床实践带来新的见解。
我们检索了八个数据库，包括PubMed、Embase、Web of Science、Cochrane对照试验中央注册库、中国生物医学文献数据库（CBM）、中国科技期刊（VIP）数据库、中国知网（CNKI）数据库和万方数据库，以查找从数据库建立至2023年1月期间针刺相关疗法治疗PSCI的随机对照试验（RCT）。两名研究人员独立评估纳入研究的偏倚风险并提取研究数据。使用Rev. Man 5.4软件进行直接比较的成对荟萃分析。使用STATA 17.0和R4.2.4软件进行贝叶斯网络荟萃分析（NMA）。使用推荐分级、评估、制定与评价（GRADE）系统评估纳入研究的证据质量。通过阅读纳入研究的全文收集与针刺疗法相关的不良反应（AE），以评估针刺疗法的安全性。
本研究共纳入62项RCT（3项三臂试验和59项两臂试验），涉及5073名参与者。在成对荟萃分析中，与认知训练相比，大多数针刺相关疗法对PSCI患者的认知功能和日常生活自理能力有积极影响。贝叶斯NMA结果表明，眼针加认知训练（79.7%）是改善MMSE评分的最佳针刺疗法，头针加认知训练位居第二（73.7%）。MoCA结果表明，温针加认知训练（86.5%）是最佳针刺疗法。在日常生活自理能力改善方面，头针加体针（87.5%）是改善MBI评分的最佳针刺疗法。最常见的轻微AE包括皮下血肿、头晕、嗜睡和面色苍白。
根据我们的贝叶斯NMA结果，眼针加认知训练和温针加认知训练是改善认知功能最有效的针刺治疗方法，而头针加体针是改善PSCI患者日常生活自理能力表现的最佳针刺治疗方法。纳入研究中未发现严重不良反应，针刺治疗似乎安全可靠。然而，由于纳入研究方法学质量较低，我们的研究结果需谨慎对待。迫切需要高质量研究来验证我们的研究结果。
https://www.crd.york.ac.uk/prospero/#recordDetails，标识符：CRD42022378353。
