Wu Zhennan, Liu Chang, Chan Vickie, Wu Xiaofeng, Huang Fan, Guo Zining, Liu Wenhao, Lu Liming, Xu Nenggui
South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
Research Centre of Basic Integrative Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
Front Aging Neurosci. 2024 Nov 11;16:1462851. doi: 10.3389/fnagi.2024.1462851. eCollection 2024.
Although numerous studies have explored acupuncture for alleviating Parkinson's disease (PD) symptoms, specific methods focusing on reducing anxiety in these patients are lacking. Preliminary research indicates that acupuncture may improve anxiety in patients with Parkinson's; however, high-quality evidence is lacking. Therefore, we conducted a meta-analysis and trial sequential analysis (TSA) to assess the efficacy of acupuncture in managing anxiety symptoms in PD.
We systematically searched eight databases for randomized controlled trials (RCTs) evaluating the efficacy of acupuncture for the treatment of anxiety in patients with PD. Primary outcomes were measured using the Hamilton Anxiety Scale (HAMA) and the Self-Rating Anxiety Scale (SAS). Secondary outcomes included the Parkinson's Disease Questionnaire-39 (PDQ-39) and the Unified Parkinson's Disease Rating Scale (UPDRS). Risk of bias was assessed using the Cochrane RoB 2.0 tool, and certainty of evidence was assessed using the GRADE system. The Trial Sequential Analysis (TSA) was used to assess the sufficiency of the evidence.
Our meta-analysis included 14 studies. The Manual acupuncture (MA) + routine drug treatment (RDT) group improved more than the RDT alone group. MA was more effective than sham acupuncture. MA+ traditional Chinese medicine (TCM) was also more effective than TCM. Auricular therapy (AT) was not as effective as control therapy (CT). The Electroacupuncture (EA) + routine drug treatment (RDT) group was not as effective as RDT. PDQ-39 and UPDRS subgroup analysis showed that the acupuncture group had better clinical efficacy than CT. The GRADE assessment rated the overall certainty of evidence for anxiety outcomes as low, PDQ-39 as very low and UPDRS as low. TSA results indicate insufficient evidence; further high-quality RCTs are needed to substantiate these findings.
Our analysis suggests that MA combined with RDT may help ameliorate anxiety in PD patients, although the evidence is weak due to low quality RCTs. EA and AT showed no significant effects, highlighting the need for more rigorous studies with better controls and longer follow-up. The potential of acupuncture for PD-related anxiety should be considered with caution until stronger evidence becomes available.
尽管众多研究探讨了针刺疗法缓解帕金森病（PD）症状的效果，但针对减轻这些患者焦虑的具体方法仍较为缺乏。初步研究表明，针刺疗法可能改善帕金森病患者的焦虑症状；然而，高质量证据尚显不足。因此，我们进行了一项荟萃分析和试验序贯分析（TSA），以评估针刺疗法对帕金森病患者焦虑症状的管理效果。
我们系统检索了八个数据库，查找评估针刺疗法治疗帕金森病患者焦虑症疗效的随机对照试验（RCT）。主要结局指标采用汉密尔顿焦虑量表（HAMA）和自评焦虑量表（SAS）进行测量。次要结局指标包括帕金森病问卷-39（PDQ-39）和统一帕金森病评定量表（UPDRS）。使用Cochrane RoB 2.0工具评估偏倚风险，并使用GRADE系统评估证据的确定性。试验序贯分析（TSA）用于评估证据的充分性。
我们的荟萃分析纳入了14项研究。手针（MA）+常规药物治疗（RDT）组的改善程度优于单纯RDT组。MA比假针刺更有效。MA+中药（TCM）也比单纯TCM更有效。耳针疗法（AT）不如对照疗法（CT）有效。电针（EA）+常规药物治疗（RDT）组不如RDT有效。PDQ-39和UPDRS亚组分析表明，针刺组的临床疗效优于CT组。GRADE评估将焦虑结局的总体证据确定性评为低，PDQ-39为极低，UPDRS为低。TSA结果表明证据不足；需要进一步开展高质量的RCT来证实这些发现。
我们的分析表明，MA联合RDT可能有助于改善帕金森病患者的焦虑症状，尽管由于RCT质量较低，证据较为薄弱。EA和AT未显示出显著效果，这凸显了开展更严格、控制更好且随访时间更长研究的必要性。在获得更有力的证据之前，应谨慎考虑针刺疗法治疗帕金森病相关焦虑的潜力。
