针刺治疗儿童抽动障碍随机对照试验的Meta分析

A Meta-analysis on Randomized Controlled Trials of Acupuncture in Treatment of Children with Tic Disorders

目的:评价针刺治疗儿童抽动障碍(TD)的有效性及安全性。方法:检索Medline、Embase、CBM、CNKI等数据库自建库起发表的针刺治疗TD的随机对照试验(RCTs),进行文献筛选后,以Jadad评分量表进行质量评价,并采用Rev Man 5.3进行Meta分析。结果:共纳入29个RCTs,均为低质量文献,累计患儿2325例。Meta分析显示:针刺或联用常规西药相对于常规西药,均可提高临床总有效率[OR=2.94,95%CI(2.24,3.85),P<0.000 01][OR=2.98,95%CI(1.53,5.82),P=0.001],减少耶鲁综合抽动严重程度量表(YGTSS)总评分[SMD=-1.29,95%CI(-1.87,-0.70),P<0.000 1][SMD=-0.71,95%CI(-1.11,-0.32),P=0.000 4];针刺联合心理行为疗法降低YGTSS总评分优于常规西药联用心理行为疗法[SMD=-0.47,95%CI(-0.84,-0.11),P=0.01],而总有效率无统计学差异;针刺联用常规西药与心理行为疗法提高总有效率优于常规西药联用心理行为疗法[OR=2.11,95%CI(1.04,4.27),P=0.04],而YGTSS总评分无统计学差异。仅有2项研究报告了不良反应。结论:针刺可作为治疗儿童抽动障碍的单一疗法或常规治疗(常规西药及心理行为疗法)的辅助疗法,但因纳入研究的质量较低,部分亚组纳入文献数量较少,且存在发表、信息等偏倚的可能,使得上述结论仍需更多高质量、大样本、多中心随机对照试验进行验证。

Objective ： To evaluae the efficacy and safety of acupuncture for Tic Disorders （TD）. Methods ： A literature search in Medline, Embase, Cochrane Library, CBM and CNKI was conducted to retrieve Randomized controlled trials （RCTs） of acupuncture in treating TD, then the included RCTs were graded with Jadad scale, and analyzed using RevMan 5.3. Results ： Twenty - nine RCTs including 2325 cases of children with TD were included in this study, and all belonged to low quality. Meta analysis showed that acupuncture alone or combined with Western medicine, compared with Western medicine alone, could significantly increase the total effective rate [ OR = 2.94,95% CI （ 2.24,3.85 ） , P 〈 0. 000 01 ] [ OR = 2.98,95 % CI （ 1.53,5.82 ）, P = 0. 001 ] and reduce the YGTSS total score [ SMD = - 1.29,95 % CI （ -1.87,-0.70）,P〈0.000 1][SMD= -0.71,95%CI（ -1.11, -0.32）,P=0.0004]. Compared with Western medicine plus psychological behavior therapy, YGTSS total score could be significantly induced in the acupuncture com- bined with psychological behavior therapy group [ SMD = -0.47,95 % CI （ -0.84, -0.11 ） , P = 0. 01 ] , but no statistical difference in the total effective rate between the two groups. Compared with Western medicine combined with psychological behavior therapy, the total effective rate could be significantly increased in the acupuncture combined with psychological behavior therapy as well as Western medicine group [ OR = 2.11,95 % CI （ 1.04, 4.27 ）, P = 0.04 ], but there was no statistical difference in YGTSS total score between the two groups. Just two studies reported the adverse events. Conclusion： Acupuncture can be used as a monotherapy or adjuvant therapy to converntional therapy （Western medicine and psychological behavior therapy）, but due to the poor quality of included studies, the small size number of RCTs in some subgroups, potential publication bials, information bias and other bias sources, further more high - quality, large sample and multi -center RCTs are needed to certify the above findings.