针刺治疗中风后手功能障碍系统评价及Meta分析

Systematic Review and Meta-analysis of Acupuncture Treatment for Post-stroke Hand Dysfunction

目的系统评价针刺治疗中风后手功能障碍的临床疗效。方法计算机检索中国知网数据库(CNKI)、重庆维普中文科技期刊数据库(VIP)、中国生物医学文献数据库网络版(CBM)、万方数据库、PubMed和Cochrane Library。时间从建库(刊)到2018年4月。按照纳入、排除标准筛选文献并进行质量评价和资料提取,对异质性较小的文献采用Rev Man5.3进行Meta分析,否则进行定性分析。结果最终纳入10项研究。改善手痉挛程度的MAS评分显示,治疗组优于对照组,差异具有统计学意义[MD=﹣0.97,95%CI(﹣1.16,﹣0.77),P<0.01]。在改善患者日常生活自理能力MBI评分显示,治疗组优于对照组,差异具有统计学意义[MD=7.07,95%CI(3.96,10.17), P<0.01]。在反映手活动功能的FMA评分方面,治疗组疗效优于对照组,差异具有统计学意义。结论针刺治疗中风后手功能障碍患者有一定的效果,但由于纳入研究的偏倚风险多为不清楚、无随访及报告结局时点不一致、结局指标量表评价可能存在主观性等原因,研究结论还需谨慎对待,尚需要大样本、高质量的随机对照试验进行进一步的验证。

Objective To systematically assess the clinical efficacy of acupuncture in treating post-stroke hand dysfunction. Method A computer search was made of China National Knowledge Infrastructure （CNKI）, Chongqing VIP Chinese Sci-Tech Journal Database （VIP）, Chinese Biomedical Literature Online Database （CBM）, Wangfang Data, PubMed and Cochrane Library. The retrieval time was limited from database construction to Apr, 2018. According to the inclusion and exclusion criteria, the retrieved literature was screened and qualitatively assessed and the data were collected. A meta-analysis of literature of small heterogeneity was made using RevMan 5.3. Otherwise, a qualitative analysis was carried out. Result Finally, 10 studies were included. MAS assessments showed that hand spasm was reduced more in the treatment group than in the control group and the difference had statistical significance [MD= -0.97, 95%CI （-1.16, -0.77）, P〈0.00001]. MBI assessments showed that the activities of daily living improved more in the treatment group than in the control group and the difference had statistical significance [MD=7.07, 95%CI （3.96, 10.17）, P〈0.00001]. FMA assessments showed that hand motor function improved more in the treatment group than in the control group and the difference had statistical significance. Conclusion Acupuncture has a certain therapeutic effect on post-stroke hand dysfunction. Because the bias risk of the included studies is not clear, no follow-up and inconsistent report ending points exist and outcome measure scale assessment may have subjectivity, the research conclusions needto be treated with caution. Large-sample and high-quality randomized controlled trials are required for further validation.