针刺百会、神庭穴治疗脑卒中后认知功能障碍效果的系统评价

Therapeutic Efficacy of Acupuncture at Baihui(GV 20) and Shenting(GV 24) for Post-stroke Cognitive Impairment: A Systematic Review

目的系统评价针刺百会、神庭穴治疗脑卒中后认知功能障碍(PSCI)的临床疗效。方法采用计算机检索中国期刊全文数据库、万方数据库、中国生物医学文献数据库、中文科技期刊数据库、Pub Med、康健临床决策循证数据库、the Cochrane Library,手动检索《中国针灸》《上海针灸杂志》两本杂志,检索时限至2013年12月31日止已发表中、英文文献。纳入针刺取穴含百会、神庭穴治疗脑卒中后认知功能障碍的随机对照试验。根据资料提取表提取数据,用Cochrane系统评价手册中的文献质量评价标准对纳入文献进行评价,用Rev Man5.0软件进行Meta分析。结果最终纳入22个临床试验共1637例受试者,Meta分析结果显示,针刺取穴含百会穴和神庭穴干预组的康复效果优于单纯认知康复训练或药物,且差异有统计学意义,MMSE评分[WMD=3.37,95%CI(1.70,5.05),P<0.00001],P300潜伏期[WMD=-17.31,95%CI(-19.70,-14.93),P<0.00001],P300振幅[WMD=1.22,95%CI(0.84,1.59),P<0.00001]。未发现严重不良反应。结论针刺取百会、神庭穴可有效改善PSCI患者的认知功能,然而对于PSCI的诊断标准和评价指标有待进一步规范、统一,且针刺干预PSCI的临床研究的方法学有待进一步提高。

Objective To evaluate the clinical efficacy of acupuncture at Baihui （GV 20） and Shenting （GV 24） in treating post-stroke cognitive impairment （PSCI） by using the systematic review method. Method Via computer, Chinese Journal Full-text Database （CJFD）, Wanfang, China Biology Medicine disc （CBMdisc）, Chinese Science and Technology Periodical Database, PubMed, Foreign Evidence-Based Medicine （FEMB）, the Cochrane Library were retrieved. Chinese Acupuncture and Moxibustion and Shanghai Journal of Acupuncture-moxibustion were manually retrieved. Randomized controlled trials published before Jan 31st of 2013 on acupuncture at Baihui （GV 20） and Shenting （GV 24） in treating PSCI, both in Chinese and English, were collected. The required data were extracted, then were evaluated according to the criteria of Cochrane systematic review and underwent meta-analysis by using RevMan 5.0. Result Twenty-two clinical trials were finally recruited, including 1 637 subjects. The meta-analysis showed that acupuncture at acupoints including Baihui （GV 20） and Shenting （GV 24） produced a more significant rehabilitation result compared to single rehabilitation training or medication. The comparison of Mini-Mental State Examination （MMSE） score showed： [WMD=3.37, 95%CI （1.70, 5.05）, P〈0.00001]; the comparison of P300 latency： [WMD=1.22, 95%CI （0.84, 1.59）, P〈0.00001]. Severe adverse reactions were not discovered. Conclusion Acupuncture at Baihui （GV 20） and Shenting （GV 24） can effectively improve the cognitive function of PSCI patients. However, the diagnostic criteria and evaluation indexes are expected to be unified and standardized, and the clinical trials on acupuncture intervening PSCI are required to be further improved methodologically.