小儿推拿治疗孤独症的疗效及安全性的系统评价

Efficacy and Safety of Massage in the Treatment of Children with Autistic Spectrum Disorders:A Systematic Evalution and Meta-analysis

目的:探讨小儿推拿治疗孤独症(autistic spectrum disorders,ASD)的疗效和安全性。方法:计算机检索中英文数据库中小儿推拿治疗ASD的临床随机对照试验(RCT),检索时限均从建库至2023年12月18日,语言限制为中英文。采用RCT偏倚风险评价工具对纳入研究的方法学质量进行评价,RevMan 5.4.1软件进行Meta分析。结果:共纳入21个RCT,包含1477例患儿。Meta分析显示,与常规康复相比,联用小儿推拿等中医特色治疗可提高临床疗效[OR=3.38,95%CI(2.41,4.74),P<0.00001],降低ABC量表[MD=-8.89,95%CI(-10.22,-7.57),P<0.00001]、CARS量表[MD=-6.74,95%CI(-9.08,-4.40),P<0.00001]及ATEC量表[MD=-10.59,95%CI(-13.55,-7.64),P<0.00001]评分,尤其在改善ASD患儿感觉[MD=-2.43,95%CI(-3.81,-1.05),P=0.0005]、躯体运动[MD=-1.27,95%CI(-1.87,-0.67),P<0.0001]、交往[MD=-2.05,95%CI(-2.97,-1.12),P<0.0001]及生活自理能力方面[MD=-0.73,95%CI(-2.22,-0.75),P=0.003],差异有统计学意义(P=0.02),但对语言交流方面未显示出优势[MD=-0.69,95%CI(-1.15,-0.24),P=0.33]。结论:与常规干预相比,联用推拿可明显缓解ASD核心症状及胃肠症状,改善ASD患儿总体健康状况,且无不良反应,患儿接受度和依从性高。但受原始研究样本量和方法学质量的影响,未来仍需要更多高质量临床研究及动物实验加以验证,为ASD人群制定个体化治疗策略提供依据。

Objective:To explore the efficacy and safety of pediatric massage in the treatment of autistic spectrum disorders(ASD).Methods:A computer search was performed for clinical randomized controlled trials(RCTs)of pediatric massage in the treatment of ASD in Chinese and English databases.The search time was from the establishment of the database to December 18,2023,and the language restrictions were Chinese and English.The RCT bias risk assessment tool was used to evaluate the methodological quality of the included studies,and RevMan 5.4.1 software was used for meta-analysis.Results:A total of 21 RCTs were included,involving 1477 children.Meta-analysis showed that compared with conventional rehabilitation,combined with TCM treatments such as pediatric massage could improve clinical efficacy[OR=3.38,95%CI(2.41,4.74),P<0.00001],reduce ABC scale[MD=-8.89,95%CI(-10.22,-7.57),P<0.00001],CARS scale[MD=-6.74,95%CI(-9.08,-4.40),P<0.00001]and ATEC scale[MD=-10.59,95%CI(-13.55,-7.64),P<0.00001]scores,especially in improving the sensory[MD=-2.43,95%CI(-3.81,-1.05),P=0.0005]and somatic motor functions in children with ASD.There were significant differences in the following aspects:communication[MD=-1.27,95%CI(-1.87,-0.67),P<0.0001],communication[MD=-2.05,95%CI(-2.97,-1.12),P<0.0001]and self-care ability[MD=-0.73,95%CI(-2.22,-0.75),P=0.003](P=0.02),but no advantage was shown in language communication[MD=-0.69,95%CI(-1.15,-0.24),P=0.33].Conclusion:Compared with conventional intervention,combined massage can significantly relieve the core symptoms and gastrointestinal symptoms of ASD,improve the overall health of children with ASD,and has no adverse reactions.The children have high acceptance and compliance.However,due to the sample size and methodological quality of the original study,more high-quality clinical studies and animal experiments are still needed in the future to verify and provide a basis for formulating individualized treatment strategies for ASD people.