穴位埋线治疗脑卒中后早期肩手综合征的系统评价与Meta分析

Acupoint catgut embedding for early post-stroke shoulder-hand syndrome:a systematic review and Meta-analysis

目的:系统评价穴位埋线对脑卒中后早期肩手综合征(shoulder-hand syndrome,SHS)的有效性与安全性。方法:计算机检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库(WanFang database)、维普数据库(VIP)、PubMed、EMbase、the Cochrane Library中关于穴位埋线治疗脑卒中后早期SHS的临床随机对照试验(RCT),检索时限均为建库至2019年9月。严格按照纳入与排除标准筛选纳入文献,采用澳大利亚JBI循证卫生保健中心对RCT的真实性评价工具评价文献质量,提取纳入文献资料信息,采用RevMan 5.2进行数据的统计与分析。结果:共纳入10项RCT,包括640例病人。Meta分析结果显示:穴位埋线治疗脑卒中后早期SHS的临床总有效率[OR=3.43,95%CI(1.97,6.00),P<0.000 1]、患肢疼痛视觉模拟评分(VAS)[MD=-1.36,95%CI(-1.76,-0.96),P<0.000 01]、上肢运动功能Fugel-Meyer量表(FMA)评分[MD=8.19,95%CI(5.00,11.39),P<0.000 01]、日常生活能力Barthel指数[MD=7.94,95%CI(4.53,11.34),P<0.000 01]GRADE证据质量等级分别为"中""低""低""低"。安全性评价:纳入的10项RCT中有3项报告未发现严重不良反应,其余7项RCT均未报告不良反应。结论:现有证据表明穴位埋线能提高脑卒中后早期SHS临床总有效率,减轻患肢疼痛,改善患侧上肢运动功能,提高日常生活能力,无严重不良反应的发生;鉴于研究方法学质量和样本量的限制,穴位埋线治疗脑卒中后早期SHS远期疗效和安全性仍需进一步考证。

Objective:To systematically evaluate the efficacy and safety of acupoint catgut embedding for early post-stroke SHS.Methods:China National Knowledge Infrastructure,Chinese Biology Medicine Database,WanFang database,VIP database,PubMed,EMbase,and the Cochrane Library were searched from their inception to September 2019.Randomized controlled trials that evaluated the add-on effects of acupoint catgut embedding to rehabilitation for early post-stroke SHS were identified.To screen RCTs according to the inclusion and exclusion criteria.Methodological quality assessment was performed using the Australian JBI Evidence-Based Health Care Center′s authenticity evaluation tool for RCT.Effective data were extracted from the included RCTs.And statistical analysis was performed using RevMan 5.2.Results:A total of 10 RCTs were included,including 640 patients.According to the results of meta-analysis,the total clinical effective rate showed that[OR=3.43,95%CI(1.97,6.00),P<0.0001],the Visual Analogue Scale of pain showed that[MD=-1.36,95%CI(-1.76,-0.96),P<0.00001],the Fugl-Meyer Assessment showed that[MD=8.19,95%CI(5.00,11.39),P<0.00001],the Barthel Index of daily living activities showed that[MD=7.94,95%CI(4.53,11.34),P<0.00001].Safety evaluation:In the 10 RCTs,no serious adverse reactions were found in the 3 RCTs,and the remaining 7 RCTs did not report adverse reactions.The certainty of evidence by GRADE are:“moderate”“low”“low”“low”.Conclusions:Cunent evidences showed that acupoint catgut embedding could effectively improve the clinical effect of early post-stroke SHS,reduce the upper limb pain,improve motor function of the upper limb,improve activities of daily living.Due to the limitation of study sample size and method quality,we need more further researches to observe the long-term efficacy and safety of acupoint embedding therapy for early post-stoke SHS.