针刺结合镜像疗法治疗脑卒中后运动障碍：一项荟萃分析和系统评价。

BACKGROUND: Dyskinesia is one of the most common complications of stroke. Acupuncture therapy (AT) and mirror therapy (MT) are promising rehabilitation measures for the treatment of post-stroke dyskinesia. Although some studies suggested that AT and MT are effective and safe for dyskinesia, the effects, and safety remain uncertain due to lacking strong evidence. The purpose of this study is to investigate the efficacy and safety of AT combined with MT in the treatment of post-stroke dyskinesia. METHODS: We searched the following databases: PubMed, Web of Science, Cochrane Library, EMBASE, Medline, China Knowledge Network, WANFANG, and China Biomedical Literature Database, from inception to 1 January 2023 to identify eligible studies. Total effective rate, the Fugl-Meyer assessment scale (FMA) upper and lower limb scores, modified Barthel index scores, Berg balance scale, modified Ashworth scale, and adverse reactions were adopted as outcome indicators. The Grading of Recommendations Assessment Development and Evaluation system was used by 2 independent reviewers to assess the quality of evidence for the outcome indicators included in the study. The statistical analysis was conducted by RevMan V.5.4 software. RESULTS: A total of 24 randomized controlled studies included 2133 patients with post-stroke dyskinesia were included. The total effective rate of AT combined with MT was more advantageous in the treatment of post-stroke dyskinesia (relative risk = 1.31, 95% confidence interval [CI] [1.22-1.42], Z = 6.96, P < .0001). AT combined with MT was more advantageous for FMA upper limb score (mean difference [MD] = 6.67, 95% CI [5.21-8.13], Z = 8.97, P < .00001) and FMA lower limb score (MD = 3.72, 95% CI [2.81-4.63], Z = 7.98, P < .00001). Meta-analysis showed that AT combined with MT for post-stroke dyskinesia had a more advantageous modified Barthel index score (MD = 9.51, 95% CI [7.44-11.58], Z = 9.01, P < .00001). CONCLUSION: AT combined with MT is effective in improving motor function and daily living ability of patients, especially in improving muscle spasms. However, these results should be regarded with caution given the low quality of evidence for the evaluation results.

背景：运动障碍是中风最常见的并发症之一。针刺疗法（AT）和镜像疗法（MT）是治疗中风后运动障碍的有前途的康复措施。尽管一些研究表明 AT 和 MT 对运动障碍有效且安全，但由于缺乏强有力的证据，其疗效和安全性仍不确定。本研究旨在探讨 AT 联合 MT 治疗中风后运动障碍的疗效和安全性。

方法：我们检索了以下数据库：PubMed、Web of Science、Cochrane 图书馆、EMBASE、Medline、中国知网、万方和中国生物医学文献数据库，从建库到 2023 年 1 月 1 日，以确定合格的研究。总有效率、Fugl-Meyer 评估量表（FMA）上肢评分、改良巴氏指数评分、Berg 平衡量表、改良 Ashworth 量表和不良反应被用作结局指标。由 2 名独立评审员使用推荐评估、制定与评价系统（Grading of Recommendations Assessment Development and Evaluation system）对纳入研究的结局指标的证据质量进行评估。统计分析采用 RevMan V.5.4 软件进行。

结果：共纳入 24 项随机对照研究，包括 2133 例中风后运动障碍患者。AT 联合 MT 治疗中风后运动障碍的总有效率更高（相对风险=1.31，95%置信区间[CI] [1.22-1.42]，Z=6.96，P<.0001）。AT 联合 MT 更有利于 FMA 上肢评分（均数差[MD]=6.67，95%CI [5.21-8.13]，Z=8.97，P<.00001）和 FMA 下肢评分（MD=3.72，95%CI [2.81-4.63]，Z=7.98，P<.00001）。Meta 分析显示，AT 联合 MT 治疗中风后运动障碍患者的改良巴氏指数评分（MD=9.51，95%CI [7.44-11.58]，Z=9.01，P<.00001）更有利。

结论：AT 联合 MT 治疗中风后运动障碍有效，能改善患者的运动功能和日常生活能力，尤其能改善肌肉痉挛。然而，由于评价结果的证据质量较低，这些结果应谨慎看待。