针刺时机对首次中风患者发病后6个月功能障碍的影响:前瞻性队列研究

Effect of acupuncture timing on functional impairment at 6 months post-onset in patients with first-ever stroke:a prospective cohort study

目的:观察急性期介入针刺对首次中风患者发病后6个月功能障碍的影响,为真实世界中风患者选择更优针刺时机提供证据。方法:将601例首次中风患者根据首次接受针刺治疗是否在临床急性期分为急性期介入组(病程≤14 d,256例)和非急性期介入组(病程15~90 d,345例),于入组时采集基线资料;于发病6个月进行随访,主要随访信息包括改良Rankin量表(mRS)评分、针刺总次数、合并应用疗法(艾灸、拔罐、推拿和康复治疗)总次数、复发情况、死亡事件及残障分类,采用多因素logistic回归分析法分析针刺介入时机与中风患者发病6个月残障风险的关联性,采用mRS评分移行法评价针刺介入时机对患者发病后6个月功能改善度的影响。结果:未调整混杂因素时,与非急性期介入组比较,急性期介入组降低了发病6个月后残障结果的风险(OR=0.434,95%CI:0.309-0.609,P=0.000);在调整病情程度、针刺次数和拔罐次数变量后,与非急性期介入组比较,急性期介入组降低了发病6个月后残障结果的风险(OR=0.588,95%CI:0.388-0.890,P=0.012);在调整病情程度、针刺次数、拔罐次数、性别、烟酒史、合并症、诊断所有混杂因素后,与非急性期介入组比较,急性期介入组降低了发病6个月后残障结果的风险(OR=0.629,95%CI:0.408-0.971,P=0.036)。两组首次中风患者发病6个月后较入组时mRS评分分布均整体向低分移行,急性期介入组较非急性期介入组在发病6个月后m RS评分分布向低分移行更明显。结论:真实世界中,首次中风患者在急性期介入针刺较非急性期介入针刺能够降低发病6个月后的残障风险,改善发病6个月后的功能状态。

Objective To observe the effect of acupuncture intervention in the acute phase on functional impairment at 6 months post-onset in patients with first-ever stroke,and provide evidence for selecting optimal acupuncture timing in the real-world setting.Methods A total of 601 patients with first-ever stroke were divided into an acute intervention group(onset within 14 days,256 cases)and a non-acute intervention group(onset between 15 and 90 days,345 cases)based on whether they received acupuncture treatment in the acute phase.The assessments were conducted at baseline and 6 months post-onset,including modified Rankin scale(mRS)score,total number of acupuncture sessions,total number of combined therapies(moxibustion,cupping,tuina and rehabilitation treatment),recurrence,death events and disability.Logistic regression analysis was used to analyze the association between acupuncture timing and the risk of disability at 6 months postonset.The mRS transition method was employed to assess the effect of acupuncture timing on functional improvement at 6months post-onset.Results Without adjusting for confounding factors,compared with the non-acute intervention group,the patients in the acute intervention group had reduced risk of disability at 6 months post-onset(OR=0.434,95%CI:0.309-0.609,P=0.000).After adjusting for variables i.e.severity of illness,number of acupuncture sessions,and number of cupping sessions,compared with the non-acute intervention group,the patients in the acute intervention group had reduced risk of disability at 6 months post-onset(OR=0.588,95%CI:0.388-0.890,P=0.012).After adjusting for all confounding factors,including severity of illness,number of acupuncture sessions,number of cupping sessions,gender,smoking and drinking history,comorbidities,and diagnosis,compared with the non-acute intervention group,the patients in the acute intervention group continued to have a reduced risk of disability at 6 months post-onset(OR=0.629,95%CI:0.408-0.971,P=0.036).Both groups showed an overall shift towards lower m RS scores at 6 months post-onset compared to baseline,with a more significant shift towards lower scores in the acute intervention group than the non-acute intervention group.Conclusion In the realworld setting,acupuncture intervention in the acute phase in patients with first-ever stroke,compared to acupuncture intervention after the acute phase,reduces the risk of disability at 6 months post-onset and improves functional status.