不同针灸疗法治疗中风后肩痛的网状Meta分析

Network Meta-analysis on Clinical Effects of Different Acupuncture Therapy in Treatment of Post-stroke Shoulder Pain

目的:采用网状Meta分析方法评价不同针刺疗法治疗中风后肩痛的有效性。方法:计算机检索中国知网(CNKI)、万方数据库(WANFANG DATA)、中国生物医学文献数据库(CBM)、维普数据库(VIP)、PubMed、Cochrane library(2018年第2期)数据库,搜集有关针灸疗法治疗中风后肩痛的临床随机对照试验。数据由两名评价者按照Cochrane系统评价手册的要求单独提取,并交叉核对,采用Stata 14.0和GeMTC 0.14.3软件行数据分析。结果:最终纳入25个临床随机对照试验,共1898例中风后肩痛患者。网状Meta分析结果示:在临床总有效率方面,针刺+康复与针刺+推拿+火罐优于康复疗法。在改善上肢运动功能积分(Fugl-Meyer motor assessment scale,FMA)方面,针刺+康复、针刺+关节松动术+康复均优于康复、针刺。在改善日常生活活动能力积分(modified Barthel index,MBI)方面,针刺+康复、针刺+推拿+火罐均优于康复、针刺;针刺+推拿+火罐优于针刺+康复、针刺+中药薰洗+康复。结论:8种不同针刺方法在治疗中风后肩痛方面,总体表现为针灸综合疗法优于单一针灸疗法和康复治疗,且单纯针灸疗法和康复治疗差异无统计学意义,各类针刺综合疗法也互有优劣,建议结合临床实际情况及中医辨证合理选择。

Objective: To evaluate the clinical efficacy of different acupuncture therapy for post - stroke shoulder pain by using network meta-analysis. Methods: Randomized controlled trials ( RCTs) of acupuncture therapy for post-stroke shoulder pain were retrieved from CNK1, WANFANG DATA, CBM , VIP, PubMed and Cochrane library ( Issue 2 , 2018 ). Date were extracted and evaluated by two reviewers independently according to Cochrane Reviewers' Handbook. The Stata 14. 0 and GeMTC 0. 14. 3 software was used for Network ineta-analysis. Results: 25 RCTs involving 1898 cases were included. The results of Network Meta-analysis showed that: for the clinical effects, acupuncture plus rehabilitation training and acupuncture plus massage plus cupping were superior to rehabilitation training. For FMA score, acupuncture plus rehabilitation training and acupuncture plus joint loose treatment plus rehabilitation training were superior to rehabilitation training and acupuncture. For MBI score, acupunclure plus rehabilitation training and acupuncture plus massage plus cupping were superior to rehabilitation training and acupuncture;acupuncture plus massage plus cupping were superior to acupuncture plus rehabilitation training and acupuncture plus traditional Chinese medicine kaorti wash plus rehabilitation training. Conclusion : Current evidences suggested that acupuncture combined therapy were superior to the acupuncture or rehabilitation therapy res|actively. There was no significant difference between acupuncture and rehabilitation therapy, and all kinds of acupuncture combined therapy also had advantages and disadvantages. When selecting treatment regimen, it is better to consider the clinical situationand TCM syndrome differentiation.