针刺治疗脑卒中后肢体运动功能障碍的Meta分析

Meta Analysis of Acupuncture for Limb Motor Dysfunction after Cerebral Apoplexy

目的:系统评价针灸结合康复治疗脑卒中后肢体运动功能障碍的疗效。方法:计算机检索数据库,搜集使用针灸结合康复治疗脑卒中的相关随机对照试验(RCT),检索时限均为从建库至2016年1月。由两位评价者独立评价纳入研究的方法学质量和提取有效数据。采用Rev Man 5.2软件进行Meta分析。结果:最终纳入9个RCT,共614例患者,Meta分析结果显示:单纯针刺结合康复组的Fugl-Meyer运动功能量表评分改善明显优于康复治疗[MD=4.38,95%CI(1.42,7.35),P=0.004],异质性I^2=89%。敏感性分析发现,分别剔除这3项研究,合并效应量仍都具有统计学意义;电针结合康复组的Fugl-Meyer运动功能量表评分改善明显优于康复治疗,[MD=16.36,95%CI(8.49,24.21),P<0.000 1],异质性I^2=96%,漏斗图不对称,提示有发表偏倚。敏感性分析发现剔除各项研究后,合并效应量仍都具有统计学意义。结论:单纯针刺结合康复治疗、电针结合康复治疗对治疗前后的Fugl-Meyer运动功能评分改善幅度均优于康复治疗,差异均有统计学意义,但尚需更多大样本、设计严谨的RCT来进一步证实上述结论,以及针灸的安全性。

Objective：To systematically evaluate the efficacy of acupuncture combined with rehabilitation in treatment of limb motor dysfunction after cerebral apoplexy.Method：The computer retrieved the database and collected the related randomized controlled trials（RCT） using acupuncture and moxibustion combined with rehabilitation for cerebral apoplexy,the retrieval time was from the establishment to the January 2016.Two evaluators independently evaluated the methodological quality of the included studies and extracted effective data.Rev Man 5.2 software was used for Meta analysis.Result：The final inclusion of 9 RCT,a total of 614 patients,Meta analysis showed that the simple acupuncture combined with the rehabilitation group＇s FuglMeyer motor function scale score improved significantly better than rehabilitation therapy[MD=4.38,95%CI（1.42,7.35）,P=0.004],heterogeneous I^2=89%.Sensitivity analysis showed that the combined effects were still statistically significant after these three studies were excluded.The improvement of Fugl-Meyer motor function scale of electroacupuncture combined with rehabilitation group was obviously better than that of rehabilitation therapy[MD=16.36,95%CI（8.49,24.21）,P〈0.000 1] and heterogeneous I^2=96%,and asymmetry of funnel map,suggesting a publication bias.Sensitivity analysis found that after excluding all studies,the combined effect volume remained statistically significant.Conclusion：Simple acupuncture combined with rehabilitation therapy,electro acupuncture combined with rehabilitation therapy improved the Fugl-Meyer motor function score better than rehabilitation therapy before and after treatment,the difference are statistically significant,but more samples and rigorous RCT are needed to further confirm the above conclusions and the safety of acupuncture.