针刺结合多奈哌齐治疗阿尔茨海默病疗效的Meta分析

Effectiveness of acupuncture combined with donepezil for Alzheimer’s disease:a Meta-analysis

目的:综合分析针刺结合盐酸多奈哌齐治疗阿尔茨海默病(Alzheimer’s disease,AD)的临床疗效。方法:检索中国学术期刊全文数据库(China National Knowledge Infrastructure,CNKI)、万方数据库(Wanfang Data)、中国生物医学文献数据库(Chinese BioMedical Literature Database,CBM)、PubMed、Web of Science(SCI)数据库关于针刺结合盐酸多奈哌齐治疗AD的相关文献,检索时间均为建库至2021年2月17日。对入选文献提取认知量表、日常生活能力量表评分资料,计算治疗前后各量表评分差值及其标准差,并使用RevMan5.4软件进行数据分析。结果:共纳入7个随机对照临床试验,患者共计425例。Meta分析结果提示针药结合治疗在改善AD患者MMSE评分(MD=0.52,95%CI=0.18~0.86)及ADAS-Cog评分(MD=-1.78,95%CI=-2.47~-1.10)方面优于多奈哌齐单用。根据GRADE方法评价,MMSE、ADAS-Cog量表评分为低质量证据,MoCA、ADL量表评分为极低质量证据。结论:现阶段的临床证据表明针刺结合多奈哌齐治疗AD比单纯应用多奈哌齐更有优势,但因存在文献研究质量不高、样本量小等诸多局限,仍需更多高质量、大样本的临床试验进一步验证。

Objective:To evaluate the effectiveness of acupuncture combined with donepezil for Alzheimer’s disease(AD).Methods:China National Knowledge Infrastructure(CNKI),Wanfang Data,Chinese BioMedical Literature Database(CBM),PubMed and Web of Science were searched for relevant randomized controlled trials(RCTs)from inception to February 17,2021.The score data of cognitive scale and daily living ability scale were extracted from the selected literature,and the difference and standard deviation of each scale before and after treatment were calculated,and the data were analyzed by Rev Man 5.4 software.Results:In total,7 RCTs involving 425 participants were included in the study,212 in observation group and 213 in control group.Meta-analysis showed that acupuncture plus donepezil therapy was superior to donepezil alone in improving MMSE(MD=0.52,95%CI=0.18 to 0.86)and ADAS-Cog(MD=-1.78,95%CI=-2.47 to-1.10)scores of AD patients.On the basis of GRADE system,scores of MMSE and ADAS-Cog were evaluated as low-quality while those of Mo CA and ADL were critically low-quality.Conclusion:Current RCTs evidence indicates that combination of acupunc ture and donepezil may perform better on improving cognitive function of AD patients than donepezil alone.Further large-sample RCTs,however,are still in desperate need to be carried.