头针治疗缺血性卒中疗效的Meta分析

Effectiveness of Scalp Acupuncture for Ischemic Stroke: A Meta-analysis

目的系统评价头针治疗缺血性卒中的有效性。方法计算机检索PubMed、EMbase、MEDLINE、The Cochrane Library、CBM、CNKI、VIP和WanFang Data数据库,搜集头针治疗缺血性卒中的相关随机对照试验(RCT),检索时限均为从建库至2014年12月30日。由2位研究者独立进行文献筛选、资料提取,并评价纳入研究的偏倚风险后,采用RevMan 5.2软件进行Meta分析。结果最终纳入27个RCT,共2 741例患者。Meta分析结果显示:1在改善神经功能缺损方面,头针结合药物明显优于单纯药物治疗[MD=–5.33,95%CI(–6.71,–3.96),P<0.000 01],头针结合常规治疗明显优于单纯常规治疗[MD=–2.11,95%CI(–3.31,–0.91),P=0.000 6]。2在治疗有效率方面,头针明显优于体针[OR=0.27,95%CI(0.14,0.51),P<0.000 1],头针结合药物明显优于单纯药物[OR=0.20,95%CI(0.14,0.29),P<0.000 01],头针结合常规治疗明显优于单纯常规治疗[OR=0.12,95%CI(0.04,0.32),P<0.000 1],但头针与单纯药物治疗差异无统计学意义[OR=0.16,95%CI(0.03,0.97),P=0.05]。结论头针可能是一种有效的辅助治疗缺血性卒中的方法,与其他治疗措施联用,可明显改善神经功能缺损,但由于纳入研究存在较大的偏倚风险,证据强度较低,本研究结论尚需进一步开展设计严格的临床试验进行验证。

Objective To systematically review the effectiveness of scalp acupuncture for treating ischemic stroke.Method We searched databases including PubMed, EMbase, MEDLINE, The Cochrane Library, CBM, CNKI, VIP and WanFang Data from inception to December 30 th 2014 for randomized controlled trials（RCTs） on scalp acupuncture in the treatment of ischemic stroke. Two reviewers independently screened literature, extracted data, and assessed risk bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 27 studies involving 2 741 patients were included. The results of meta-analysis showed that： a） As for the improvement of nervous functional deficiency, the scalp acupuncture plus drug group was superior to the drug alone group（MD= –5.33, 95%CI–6.71 to –3.96, P〈0.000 01）, and the scalp acupuncture plus conventional therapy group was superior to the conventional therapy alone group（MD= –2.11, 95%CI –3.31 to –0.91, P=0.0006）. b） As for the effective rate, the scalp acupuncture group was superior to the body acupuncture group（OR=0.28, 95%CI 0.15 to 0.53, P〈0.000 01）, the scalp acupuncture plus drug group was superior to the drug alone group（OR=0.20, 95%CI 0.14 to 0.29, P〈0.000 01）, and the scalp acupuncture plus conventional therapy group was superior to the conventional therapy alone group（OR=0.12, 95% CI 0.02 to 0.56,P=0.008）. However, there was no significant difference between the scalp acupuncture group and the drug alone group（OR=0.16, 95%CI 0.03 to 0.97, P=0.05）. Conclusion Scalp acupuncture appears to be an effective adjuvant therapy method for ischemic stroke, and can significantly improve the nervous functional deficiency when combined with other treatment. However, the strength of evidence is low due to high risk of bias of the included studies. More rigorous studies are needed to verify the above conclusion.