针灸干预脑卒中后认知障碍的系统评价再评价

Acupuncture for Post-Stroke Cognitive Impairment:An Overview of Systematic Reviews and Meta-Analyses

目的对针灸治疗脑卒中后认知障碍的MAs/SRs进行方法学质量、报告质量和证据质量等级的综合评价。方法在中国知网(CNKI)、万方(Wanfang)、维普(VIP)数据库、中国生物医学文献服务系统(CBM)等4个中文数据库以及PubMed、Embase、Cochrane Central Register of Controlled Trials等3个英文数据库中对收录的针灸治疗脑卒中后认知障碍的MAs/SRs进行检索,检索时限均为建库至2022年2月20日。MAs/SRs的方法学质量评估工具为AMSTAR 2,报告质量评估工具为PRISMA,证据质量评估工具为GRADE系统。结果本文共纳入18篇MAs/SRs,89%的研究表明针灸治疗脑卒中后认知障碍具有有效性和安全性。根据AMSTAR 2显示,纳入研究的方法学质量分布情况为低质量1篇,极低质量17篇;根据PRISMA显示,1篇报告质量好,16篇报告质量中等,1篇报告质量差;GRADE评级显示,在纳入的71个结局指标中,没有证据表明存在高质量的结局指标,而中等、低、极低质量的分布情况分别为10个、17个、44个。结论针灸治疗脑卒中后认知障碍可能具有一定的有效性和安全性,但当前针灸治疗脑卒中后认知障碍的MAs/SRs质量普遍较低,应谨慎解释。

Objective To overview the methodological quality,report quality and evidence quality of the Meta-Analyses/Systematic Reviews(MAs/SRs)of acupuncture for post-stroke cognitive impairment(PSCI).Methods A search was conducted for MAs/SRs on PSCI using English or Chinese from inception to 20 February 2022 published in four Chinese databases:CNKI,Wanfang,VIP,CBM;and three English databases:PubMed,Embase and Cochrane Library.The MAs/SRs were evaluated for methodological quality using AMSTAR 2 and for reporting quality using PRISMA,and the quality of evidence was assessed using the GRADE system.Results A total of 18 MAs/SRs were included in this study,of which 89%showed the effectiveness and safety of acupuncture for PSCI.According to AMSTAR 2,1 study was of low methodological quality and 17 studies were of critically low quality;according to PRISMA,1 study was of high quality,16 studies were of moderate quality and 1 study was of poor quality;GRADE showed that of the 71 outcomes included,however,there was no evidence of high quality outcomes,with 10 of moderate quality,17 of low quality,and 44 of very low quality.Conclusion Acupuncture may be effective and safe in the treatment of PSCI,but in current acupuncture for PSCI is generally of low quality and should be interpreted with caution.