针灸治疗儿童孤独症的系统评价再评价

Re-evaluation of systematic reviews of acupuncture and moxibustion for childhood autism

目的:评价针灸治疗儿童孤独症(CA)的系统评价/Meta分析,为临床诊疗提供决策依据。方法:计算机检索PubMed、EMbase、Cochrane Library、中国生物医学文献数据库(SinoMed)、中国期刊全文数据库(CNKI)和万方数据库中针灸治疗CA的系统评价和/或Meta分析,检索时限为建库至2022年5月5日。采用PRISMA声明评价报告质量,AMSTAR 2量表评价方法学质量,气泡图构建证据图谱,GRADE系统评价证据质量。结果:共纳入9篇系统评价,PRISMA声明得分为13~26分,报告质量较低,方案和注册、检索、其他分析及基金条目报告缺失严重。方法学方面存在的主要问题为未提前确定方案、检索策略不全面、未提供排除文献清单、对异质性分析和偏倚风险的影响解释不全等。证据图谱显示,6篇结论为有效,2篇结论为可能有效,1篇结论为不确定有效。证据质量整体偏低,导致降级的最主要因素为局限性,其次是不一致性、不精确性和发表偏倚。结论:针灸治疗CA有一定疗效,但是纳入文献的报告质量、方法学质量和证据质量有待提高,建议今后开展高质量、规范的研究以提供循证依据。

Objective To re-evaluate the systematic review/Meta-analysis of acupuncture and moxibustion for childhood autism(CA), aiming to provide decision-making basis for clinical diagnosis and treatment. Methods The systematic review and/or Meta-analysis of acupuncture and moxibustion for CA were searched in PubMed, EMbase,Cochrane Library, SinoMed, CNKI and Wanfang databases. The retrieval time was from the database establishment to May 5th, 2022. PRISMA(preferred reporting items for systematic reviews and Meta-analyses) was used to evaluate the report quality, and AMSTAR 2(a measurement tool to assess systematic reviews 2) was used to evaluate the methodological quality, bubble map was used to construct the evidence map and GRADE was used to evaluate the quality of evidence.Results A total of 9 systematic reviews were included. The PRISMA scores ranged from 13 to 26. The report quality was low, and there was a serious lack in the aspects of program and registration, search, other analysis and funding. The main problems in methodology included not making prespecified protocol, incomplete retrieval strategy, not providing a list of excluded literatures, and incomplete explanation on heterogeneity analysis and bias risk. The evidence map showed that 6conclusions were valid, 2 conclusions were possible valid and 1 conclusion was uncertain valid. The overall quality of evidence was low, and the main factors leading to the downgrade were limitations, followed by inconsistency, imprecision and publication bias. Conclusion Acupuncture and moxibustion has a certain effect for CA, but the quality of reporting,methodology and evidence in included literature need to be improved. It is suggested to perform high-quality and standardized research in the future to provide evidence-based basis.