眼针为主治疗中风后肩手综合征系统评价和试验序贯分析

Systematic Review and Trial Sequential Analysis of Eye Acupuncture in Treating Post-Stroke SHS

目的:评价眼针治疗中风后肩手综合征的有效性和安全性。方法:计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、维普、万方及中国生物医学数据库从建库—2021年6月1日关于眼针治疗中风后肩手综合征的随机对照试验,同时检索纳入研究的参考文献列表、临床试验注册中心以及灰色文献。按照拟定的纳入标准与排除标准对原始文献进行筛选。采用RevMan 5.4软件进行文献质量评价,采用Stata 15.1软件进行Meta分析,采用TSA 0.9.5.10 Beta软件进行试验序贯分析。结果:共纳入10篇符合标准的文献,涉及1045名受试者。通过Meta分析发现,与对照组相比,眼针在临床总有效率、降低VAS评分及Fugl-Meyer评分方面,具有显著优势(临床总有效率方面:RR=1.39,95%CI=1.18~1.64,P=0.000<0.001;VAS评分方面:WMD=-0.88,95%CI=-1.17~-0.59,P=0.000<0.001;Fugl-Meyer评分方面:WMD=7.39,95%CI=4.85~9.92,P=0.000<0.001)。眼针疗法不良事件较少发生,安全性较高。TSA结果提示本Meta分析结果稳定,证据可靠。结论:基于现有研究的证据,眼针治疗中风后肩手综合征疗效确切,与常规康复疗效比较,在临床总有效率、缓解疼痛、提高肢体功能方面具有一定优势,但由于纳入研究方法学质量较低,仍需更多高质量临床试验研究来验证结论的可靠性。

Objective:To evaluate the efficacy and the safety of eye acupuncture in the treatment of poststroke shoulder and hand syndrome(SHS).Methods:Randomized controlled trials on eye acupuncture for the treatment of post-stroke SHS were searched from PubMed,Embase,Cochrane Library,Web of Science,CNKI,VIP,Wan Fang and Chinese Biomedical Database from establishment to June 1,2021.A list of included references,clinical trial registries and gray references were reviewed as well.The original literature was screened according to the inclusion and exclusion criteria.RevMan5.4 software was used for literature quality evaluation,Stata15.1 software was used for Meta-analysis,and TSA0.9.5.10 Beta software was used for sequential analysis.Results:A total of 10 articles meeting the criteria were included,involving 1,045 subjects.Meta-analysis showed that compared with the control group,eye acupuncture had significant advantages in total clinical effectiveness,reduction of VAS score and Fugl-Meyer score,in terms of total clinical effectiveness:RR=1.39,95%CI=1.18~1.64,P=0.000<0.001;in terms of VAS score:WMD=-0.88,95%CI=-1.17~-0.59,P=0.000<0.001;in terms of Fugl-Meyer score:WMD=7.39,95%CI=4.85~9.92,P=0.000<0.001.Eye acupuncture therapy has fewer adverse events and higher safety.TSA results suggested that the Meta-analysis was stable and the evidence was reliable.Conclusion:Based on the evidence of existing studies,eye acupuncture is effective for the treatment of post-stroke SHS.Compared with common rehabilitation therapy,it has certain advantages in clinical efficiency,pain relief and limb function improvement.However,due to the low quality of the included study methodology,more high-quality clinical trials are needed to verify the reliability of the conclusions.