中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2015, Vol. 10 ›› Issue (5): 808-813.doi: 10.4103/1673-5374.156987

• 原著:周围神经损伤修复保护与再生 • 上一篇    下一篇

针刺配合维生素B12穴位注射治疗贝尔麻痹：无高质量数据证实有提高效应

  

  • 收稿日期:2015-02-09 出版日期:2015-05-15 发布日期:2015-05-15
  • 基金资助:

    国家自然科学基金（81273848）

Acupuncture and vitamin B12 injection for Bell’s palsy: no high-quality evidence exists

Li-li Wang, Ling Guan, Peng-liang Hao, Jin-long Du, Meng-xue Zhang   

  1. Department of Acupuncture and Moxibustion, Chinese PLA General Hospital, Beijing, China
  • Received:2015-02-09 Online:2015-05-15 Published:2015-05-15
  • Contact: Ling Guan, Ph.D., guanling301@sina.com
  • Supported by:

    This study was financially supported by a grant from the National Natural Science Foundation of China, No. 81273848.

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摘要：

目的：评价针刺配合维生素B12穴位注射与单独针刺对贝尔麻痹患者不完全恢复率疗效的影响。
资料来源：采用检索词“贝尔麻痹”或“特发性面神经麻痹”或“面神经麻痹”)和(针刺或维生素B12或甲钴胺)作为关键词或主题词，检索Medline，WEB of Science, CNKI, CBM数据库2014年4月之前发表的相关文献。
资料选择：选择比较针刺配合维生素B12穴位注射和单独针刺治疗贝尔麻痹的随机对照试验进行meta分析，治疗周期>4周，并且观察指标包括不完全恢复率，评分指标可以不同但对于痊愈的定义一致。选用Relative Risks(RRs, 95%CI)作为合并效应量，所有统计分析采用Review Manager软件的固定效应模型进行统计分析。
结局评价指标：不完全恢复率作为主要观察指标。
结果：共有5篇研究344例患者纳入最后分析。分析采用Revman的固定效应模型。结果显示针刺配合维生素B12穴位注射和单独针刺治疗贝尔麻痹的不完全恢复率分别为44.5%和62.57%。主要穴位为四白(ST 2)，地仓(ST 4)，太阳(EX-HN 5)和颊车（ST 6）合并效应量证明联合组效果优于单独针刺(RR=0.71, 95% CI: 0.58-0.87; P=0.001)，将1个研究中8个失访患者排除后分析，此结果保持不变(RR=0.70, 95% CI: 0.58-0.86; P=0.0005)。在亚组分析中，配合电针组的疗效优于非电针组(P=0.024)。但是在有关药物类型及治疗时期的两个亚组分析中的不完全恢复率未见显著差异。纳入文献的方法质量学评价为中到低级质量且存在偏倚。
结论：在本组分析中，针刺配合维生素B12治疗降低了贝尔麻痹患者的不完全恢复率。但是由于文章存在偏倚及方法质量学方面的不足，所以对于是否应该在临床治疗过程中使用联合治疗仍然没有确定证据，有待更多研究证实。
 

关键词: 神经再生, 脑损伤, 面神经麻痹, 贝尔麻痹, 对照, 方法质量学, 治疗, 固定效应模型, 针刺, 不完全恢复率, 电针, 随机对照试验, 国家自然科学基金

Abstract:

OBJECTIVE: To assess the efficacy of acupuncture combined with vitamin B12 acupoint injection versus acupuncture alone to reduce incomplete recovery in patients with Bell’s palsy.
DATA RETRIEVAL: A computer-based online retrieval of Medline, Web of Science, CNKI, CBM databases until April 2014 was performed for relevant trials, using the key words “Bell’s palsy or idiopathic facial palsy or facial palsy” and “acupuncture or vitamin B12 or methylcobalamin”.
STUDY SELECTION: All randomized controlled trials that compared acupuncture with acupuncture combined with vitamin B12 in patients with Bell’s palsy were included in the meta-analysis. The initial treatment lasted for at least 4 weeks. The outcomes of incomplete facial recovery were monitored. The scoring index varied and the definition of healing was consistent. The combined effect size was calculated by using relative risk (RR) with 95% confidence interval (CI) using the fixed effect model of Review Manager.
MAIN OUTCOME MEASURES: Incomplete recovery rates were chosen as the primary outcome.
RESULTS: Five studies involving 344 patients were included in the final analysis. Results showed  that the incomplete recovery rate of Bell’s palsy patients was 44.50% in the acupuncture combined with vitamin B12 group but 62.57% in the acupuncture alone group. The major acupoints were Taiyang (EX-HN5), Jiache (ST6), Dicang (ST4) and Sibai (ST2). The combined effect size showed that acupuncture combined with vitamin B12 was better than acupuncture alone for the treatment of Bell’s palsy (RR = 0.71, 95%CI: 0.58–0.87; P = 0.001), this result held true when 8 patients lost to follow up in one study were included into the analyses (RR = 0.70, 95%CI: 0.58–0.86; P = 0.0005). In the subgroup analyses, the therapeutic effect in patients of the electroacupuncture subgroup was better than in the non-electroacupuncture subgroup (P = 0.024). There was no significant difference in the incomplete recovery rate by subgroup analysis on drug types and treatment period. Most of the included studies were moderate or low quality, and bias existed.
CONCLUSION: In patients with Bell’s palsy, acupuncture combined with vitamin B12 can reduce the risk of incomplete recovery compared with acupuncture alone in our meta-analysis. Because of study bias and methodological limitations, this conclusion is uncertain and the clinical application of acupuncture combined with vitamin B12 requires further exploration.

Key words: nerve regeneration, brain injury, facial palsy, Bell’s palsy, comparison, methodological quality, therapy, fixed effect model, acupuncture, incomplete recovery, randomized controlled trials,  , electroacupuncture, NSFC grants, neural regeneration