针刺治疗血管性痴呆系统评价与Meta分析

Acupuncture Treatment of Vascular Dementia: A Systematic Review and Meta-analysis

目的系统评价针刺疗法治疗血管性痴呆的临床治疗效果及安全性。方法采用计算机检索Cochrane Library(CENTRAL)、Pubmed、Embase、中国知网(CNKI)、中国生物医学文献(CBM)、中国维普(VIP)和中国万方等中英文数据库,检索时间从建库至2018年4月,纳入数据库中所有比较针刺疗法治疗血管性痴呆的随机对照试验,由评价者对纳入研究的质量进行评价并提取资料后,采用RevMan5.2软件进行Meta分析。结果共纳入17个随机对照试验,共1283例患者。Meta分析结果显示,对于血管性痴呆患者,采用二分类变量法研究针刺组对比药物组整体有效率,合并效应为1.28(1.14,1.44),具有统计学意义,表明针刺疗法对血管性痴呆的治疗效果优于药物组。针刺组和药物组相比在降低日常生活活动量表(ADL)的评分方面无显著差异,合并治疗效应为-1.12(-6.91,4.67),不具有统计学意义;而对于提高简易精神状态检查表(MMSE)评分及长谷川痴呆量表(HDS)评分,针刺组较药物组两者能力强,合并效应为1.49(0.91,2.07)、2.89(1.89,3.89),均有统计学意义。结论基于纳入17篇文献的Meta分析结果,针刺疗法能有效治疗血管性痴呆;但由于有待于纳入文献质量的提高、样本量扩大以及试验方法条件改善,其疗效仍需进一步验证。

Objective To systematically evaluate the treatment efficacy and safety of acupuncture in treating vascular dementia.Method Computer-based retrieval of Cochrane Library (CENTRAL),Pubmed,Embase,China National Knowledge Infrastructure (CNKI),China Biomedical Literature (CBM),VIP and Wanfang databases were conducted from their inception till April 2018.The randomized Controlled trials (RCTs) studying acupuncture treatment of vascular dementia were collected.The quality of the included studies was evaluated and the required data were extracted.Meta-analysis was performed using RevMan 5.2.Result A total of 17 RCTs were included,involving 1283 patients.The meta-analysis of dichotomous variables showed that for patients with vascular dementia,comparing the effective rate of the acupuncture group with that of the medication group,the overall effect was 1.28(1.14,1.44),with statistical significance,suggesting that acupuncture therapy should be superior to medication comparing the efficacy in treatment of vascular dementia.The overall effect was -1.12(-6.91,4.67) comparing the decrease in the score of activities of daily living (ADL) between the acupuncture group and the medication group,without statistical significance.Regarding the improvement of Mini-Mental State Examination (MMSE) and Hastgawa Dementia Scale (HDS) scores,the acupuncture group was superior to the medication group,and the overall effects were 1.49(0.91,2.07) and 2.89(1.89,3.89),respectively,both with statistical significance.Conclusion Based on the meta-analysis of the included 17 studies,acupuncture can effectively treat vascular dementia;however,limited by the low quality,small sample size and poor experimental condition of the included studies,the efficacy of the acupuncture treatment needs further verification.