{"title":"针灸治疗脑卒中后认知障碍:系统回顾和荟萃分析。","authors":"Xu Kuang, Wenjuan Fan, Jiawei Hu, Liqun Wu, Wei Yi, Liming Lu, Nenggui Xu","doi":"10.1177/09645284211009542","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to evaluate the effectiveness and safety of acupuncture for the treatment of post-stroke cognitive impairment (PSCI).</p><p><strong>Methods: </strong>The Cochrane Library, Embase, Medline, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical (VIP), Wanfang, and Chinese Biological Medicine (CBM) databases were electronically searched from their inception to 10 April 2019. The Montreal Cognitive Assessment (MoCA) scale and Mini-Mental State Examination (MMSE) scale were used as outcomes to assess effectiveness with respect to cognitive function. Assessment of risk of bias (ROB) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment were performed by two reviewers independently. Data were analyzed using Review Manager (RevMan) 5.3.</p><p><strong>Results: </strong>A total of 28 trials with 2144 participants were included in the qualitative synthesis and meta-analysis. Four of the 28 trials (14%) were assessed as being at overall low ROB, 24 of the 28 trials (86%) were assessed as having overall high ROB. The quality of evidence for both MoCA and MMSE were deemed to be very low by the GRADE criteria. Results indicated that acupuncture groups may be benefiting more than non-acupuncture groups with respect to variation of MoCA scores (merged mean difference (MMD): 2.66, 95% confidence interval (CI): 2.18 to 3.13, <i>p</i> < 0.00001; heterogeneity: χ<sup>2</sup> = 35.52, <i>p</i> = 0.0007, <i>I</i><sup>2</sup> = 63%), and the heterogeneity decreased in both subgroup analysis and sensitivity analysis. In addition, acupuncture groups might be benefiting more than non-acupuncture groups in terms of changes in MMSE score (MMD = 2.97, 95% CI = 2.13 to 3.80, <i>p</i> < 0.00001; heterogeneity: χ<sup>2</sup> = 269.75; <i>p</i> < 0.00001; <i>I</i><sup>2</sup> = 92%), and the heterogeneity decreased in subgroup analysis. Only one RCT addressed adverse events, and the symptoms were mild and did not affect treatment and evaluation.</p><p><strong>Conclusion: </strong>Acupuncture could be effective and safe for PSCI. Nevertheless, the results should be interpreted cautiously due to the high ROB of included trials and very low quality of evidence for assessed outcomes.</p>","PeriodicalId":378725,"journal":{"name":"Acupuncture in medicine : journal of the British Medical Acupuncture Society","volume":" ","pages":"577-588"},"PeriodicalIF":0.0000,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/09645284211009542","citationCount":"14","resultStr":"{\"title\":\"Acupuncture for post-stroke cognitive impairment: a systematic review and meta-analysis.\",\"authors\":\"Xu Kuang, Wenjuan Fan, Jiawei Hu, Liqun Wu, Wei Yi, Liming Lu, Nenggui Xu\",\"doi\":\"10.1177/09645284211009542\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>The aim of this study was to evaluate the effectiveness and safety of acupuncture for the treatment of post-stroke cognitive impairment (PSCI).</p><p><strong>Methods: </strong>The Cochrane Library, Embase, Medline, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical (VIP), Wanfang, and Chinese Biological Medicine (CBM) databases were electronically searched from their inception to 10 April 2019. The Montreal Cognitive Assessment (MoCA) scale and Mini-Mental State Examination (MMSE) scale were used as outcomes to assess effectiveness with respect to cognitive function. Assessment of risk of bias (ROB) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment were performed by two reviewers independently. Data were analyzed using Review Manager (RevMan) 5.3.</p><p><strong>Results: </strong>A total of 28 trials with 2144 participants were included in the qualitative synthesis and meta-analysis. Four of the 28 trials (14%) were assessed as being at overall low ROB, 24 of the 28 trials (86%) were assessed as having overall high ROB. The quality of evidence for both MoCA and MMSE were deemed to be very low by the GRADE criteria. Results indicated that acupuncture groups may be benefiting more than non-acupuncture groups with respect to variation of MoCA scores (merged mean difference (MMD): 2.66, 95% confidence interval (CI): 2.18 to 3.13, <i>p</i> < 0.00001; heterogeneity: χ<sup>2</sup> = 35.52, <i>p</i> = 0.0007, <i>I</i><sup>2</sup> = 63%), and the heterogeneity decreased in both subgroup analysis and sensitivity analysis. In addition, acupuncture groups might be benefiting more than non-acupuncture groups in terms of changes in MMSE score (MMD = 2.97, 95% CI = 2.13 to 3.80, <i>p</i> < 0.00001; heterogeneity: χ<sup>2</sup> = 269.75; <i>p</i> < 0.00001; <i>I</i><sup>2</sup> = 92%), and the heterogeneity decreased in subgroup analysis. Only one RCT addressed adverse events, and the symptoms were mild and did not affect treatment and evaluation.</p><p><strong>Conclusion: </strong>Acupuncture could be effective and safe for PSCI. 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引用次数: 14
摘要
目的:本研究的目的是评估针灸治疗脑卒中后认知功能障碍(PSCI)的有效性和安全性。方法:检索Cochrane图书馆、Embase、Medline、中国知网(CNKI)、中国科技期刊(VIP)、万方和中国生物医学(CBM)数据库自建库至2019年4月10日的电子检索结果。采用蒙特利尔认知评估(MoCA)量表和迷你精神状态检查(MMSE)量表作为评估认知功能有效性的结果。偏倚风险评估(ROB)和建议分级评估、发展和评价(GRADE)评估由两位评论者独立完成。使用Review Manager (RevMan) 5.3对数据进行分析。结果:共纳入28项试验2144名受试者进行定性综合和荟萃分析。28项试验中有4项(14%)被评估为总体低ROB, 28项试验中有24项(86%)被评估为总体高ROB。根据GRADE标准，MoCA和MMSE的证据质量都很低。结果显示，针灸组在MoCA评分变化方面可能比非针灸组获益更多(合并平均差值(MMD): 2.66, 95%可信区间(CI): 2.18 ~ 3.13, p < 0.00001;异质性:χ2 = 35.52, p = 0.0007, I2 = 63%)，亚组分析和敏感性分析异质性均有所降低。此外，针灸组在MMSE评分的变化方面可能比非针灸组受益更多(MMD = 2.97, 95% CI = 2.13 ~ 3.80, p < 0.00001;异质性:χ2 = 269.75;P < 0.00001;I2 = 92%)，亚组分析异质性降低。只有一项随机对照试验涉及不良事件，症状轻微，不影响治疗和评估。结论:针刺治疗PSCI安全有效。然而，由于纳入试验的高ROB和评估结果的证据质量非常低，结果应谨慎解释。
Acupuncture for post-stroke cognitive impairment: a systematic review and meta-analysis.
Objectives: The aim of this study was to evaluate the effectiveness and safety of acupuncture for the treatment of post-stroke cognitive impairment (PSCI).
Methods: The Cochrane Library, Embase, Medline, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical (VIP), Wanfang, and Chinese Biological Medicine (CBM) databases were electronically searched from their inception to 10 April 2019. The Montreal Cognitive Assessment (MoCA) scale and Mini-Mental State Examination (MMSE) scale were used as outcomes to assess effectiveness with respect to cognitive function. Assessment of risk of bias (ROB) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment were performed by two reviewers independently. Data were analyzed using Review Manager (RevMan) 5.3.
Results: A total of 28 trials with 2144 participants were included in the qualitative synthesis and meta-analysis. Four of the 28 trials (14%) were assessed as being at overall low ROB, 24 of the 28 trials (86%) were assessed as having overall high ROB. The quality of evidence for both MoCA and MMSE were deemed to be very low by the GRADE criteria. Results indicated that acupuncture groups may be benefiting more than non-acupuncture groups with respect to variation of MoCA scores (merged mean difference (MMD): 2.66, 95% confidence interval (CI): 2.18 to 3.13, p < 0.00001; heterogeneity: χ2 = 35.52, p = 0.0007, I2 = 63%), and the heterogeneity decreased in both subgroup analysis and sensitivity analysis. In addition, acupuncture groups might be benefiting more than non-acupuncture groups in terms of changes in MMSE score (MMD = 2.97, 95% CI = 2.13 to 3.80, p < 0.00001; heterogeneity: χ2 = 269.75; p < 0.00001; I2 = 92%), and the heterogeneity decreased in subgroup analysis. Only one RCT addressed adverse events, and the symptoms were mild and did not affect treatment and evaluation.
Conclusion: Acupuncture could be effective and safe for PSCI. Nevertheless, the results should be interpreted cautiously due to the high ROB of included trials and very low quality of evidence for assessed outcomes.
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