针灸治疗中老年帕金森病睡眠障碍的系统评价

A systematic review of acupuncture treatment of sleep disorders in middle-aged and elderly patients with Parkinson s disease

目的系统评价针灸治疗帕金森病(Parkinson's disease,PD)伴睡眠障碍的临床疗效。方法检索中国知网期刊全文数据库(CNKI)、万方学术期刊全文数据库(WANGFANG)、维普中文科技期刊数据库(VIP)、中国生物医学网(CBM)、Web of Science、PubMed、Embase各大数据库。检索时间2018年1月1日-2024年3月1日;检索关于针灸治疗PD的随机对照临床试验。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行临床系统分析。结果共纳入22项临床研究,20篇中文文献,2篇英文文献,纳入研究总受试者1606例。临床系统分析针灸结合其他疗法较对比单纯其他疗法改善情况结果显示:(1)观察组临床总有效率高于对照组,差异有统计学意义[RR=1.29,95%CI(1.09,1.54),P<0.05];(2)观察组降低患者的PSQI评分优于对照组,差异有统计学意义[MD=-2.50,95%CI(-3.49,-1.50),P<0.05];(3)相比于对照组,观察组提高患者的PDSS评分更具优势,差异有统计学意义[MD=11.13,95%CI(7.67,14.58),P<0.05];(4)观察组降低患者的UPDRS评分优于对照组,差异有统计学意义[MD=-4.57,95%CI(-5.89,-3.25),P<0.05];(5)观察组降低患者的PDQ-39评分优于对照组,差异有统计学意义[MD=-7.85,95%CI(-12.78,-2.92),P<0.05];(6)针灸能够降低PD睡眠障碍患者中医症状分级量化积分,差异有统计学意义[MD=-1.94,95%CI(-2.78,-1.10),P<0.05];(7)观察组降低患者的NMSS评分优于对照组,差异有统计学意义[MD=-6.84,95%CI(-10.60,-3.07),P<0.05]。结论针灸对PD患者的睡眠质量具有明显的改善作用,可提高患者的生活质量,且不良反应较少。

Objective To systematically evaluate the clinical efficacy of acupuncture in the treatment of Parkinson's disease(PD)complicated with sleep disorder.Methods CNKI Full-text Database(CNKI),Wanfang Full-text Database of Academic Journals(WANFANG),VIP Chinese Science and Technology Journal Database(VIP),China Biomedical Network(CBM),Web of Science,PubMed and Embase Databases were searched.The search period was from January 1,2018 to March 1,2024.Randomized controlled clinical trials on acupuncture in the treatment of PD were searched.Two researchers independently screened the literature,extracted data and evaluated the risk of bias in the included studies.Then RevMan 5.4 software was used for clinical systematic analysis.Results A total of 22 clinical studies were included,including 20 Chinese literatures and 2 English literatures.A total of 1606 subjects were included in these studies.The clinical systematic analysis of the improvement of acupuncture combined with other therapies compared with other therapies alone showed that:(1)The total clinical effective rate of the observation group was higher than that of the control group,and the difference was statistically significant[RR=1.29,95%CI(1.09,1.54),P<0.05].(2)The observation group was superior to the control group in lowering the PSQI score,and the difference was statistically significant[MD=-2.50,95%CI(-3.49,-1.50),P<0.05].(3)Compared with the control group,the observation group had a statistically significant advantages in improving the PDSS score,and the difference was statistically significant[MD=11.13,95%CI(7.67,14.58),P<0.05].(4)The observation group was superior to the control group in lowering the UPDRS score,and the difference was statistically significant[MD=-4.57,95%CI(-5.89,-3.25),P<0.05].(5)The observation group was superior to the control group in lowering the PDQ-39 score,and the difference was statistically significant[MD=-7.85,95%CI(-12.78,-2.92),P<0.05].(6)Acupuncture could reduce the score of TCM symptom grading in PD patients with sleep disorder,and the difference was statistically significant[MD=-1.94,95% CI(-2.78,-1.10),P<0.05].(7)The observation group was superior to the control group in lowering the NMSS score,and the difference was statistically significant[MD=-6.84,95% CI(-10.60,-3.07),P<0.05].Conclusion Acupuncture can significantly improve the sleep quality of PD patients,improve their quality of life,and have fewer adverse reactions.