中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2018, Vol. 13 ›› Issue (6): 1107-1117.doi: 10.4103/1673-5374.233455

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

针灸治疗脑性瘫痪：随机对照试验的荟萃分析

  

  • 收稿日期:2018-05-18 出版日期:2018-06-15 发布日期:2018-06-15
  • 基金资助:

    四川省科技厅项目（2016SZ0039, 2016），四川省医学会项目（S15063, 2015）

Acupuncture for cerebral palsy: a meta-analysis of randomized controlled trials

Ling-Xin Li1, Ming-Ming Zhang2, Yin Zhang1, Jing He1   

  1. 1 Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
    2 Chinese Cochrane Center, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
  • Received:2018-05-18 Online:2018-06-15 Published:2018-06-15
  • Contact: Jing He, yeshj028@163.com.
  • Supported by:

    This work was financially supported by the Science and Technology Department of Sichuan Province of China, No. 2016SZ0039, 2016; and a grant from the Sichuan Province Medical Association in China, No. S15063, 2015.

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摘要：

 目的：评估当前针灸治疗脑性瘫痪的疗效和安全性。

资料来源：计算机检索PUBMED (1950/2017)、EMBASE (1974/2017)、ScienceDirect (1986/2017)、学术期刊集成全文数据库(1887/2017)、Cochrane 图书馆（至2017年第4期）、SCIE(1900/2017)、CNKI(1915/2017)、CBM(1990/2017-04)、万方(1980/2017)、维普(1989/2017)和中国科学引文数据库(1989/2017)。
资料选择：纳入针灸加康复训练与单独康复的随机对照试验。收集有关运动能力、日常活动能力、有效率、智力及不良反应的数据。使用软件Revman 5.2进行统计分析。
结局评价指标：主要结局指标为运动能力、日常活动能力和有效率，次要结局指标包括智力和不良反应。

结果：共有21项研究1 718例患者符合纳入标准。针刺加康复治疗可显著改善脑性瘫痪儿童的粗大运动功能(SMD 0.64, 95% CI 0.52 to 0.76, P < 0.00001; I2 = 0%, P = 0.69; 含13项研究1144例患者)和总有效率(RR 1.28, 95% CI 1.20 to 1.37, P < 0.00001; I2 = 18%, P = 0.27; 含12项研究1 106例患者)。脑性瘫痪儿童的精细运动功能(SMD 3.48, 95% CI 2.62 to 4.34, P < 0.00001; I2 = 64%, P = 0.10; 含2项研究193例患者)、改良Ashworth评分(SMD -0.31, 95% CI -0.52 to -0.11, P = 0.003; I2 = 74%, P = 0.004; 含5项研究363例患者)和日常活动能力(SMD 1.45, 95% CI 1.20 to 1.71, P < 0.00001; I2 = 78%, P = 0.004; 含4项研究313例患者)也能经针刺加康复治疗改善。没有观察到偏倚。针灸有关的研究仅出现了轻度不良事件。
结论：针灸联合康复训练能够改善脑性瘫痪儿童的更有效地改善患儿粗大运动功能，降低肌痉挛，提高日常生活活动能力，但由于纳入的随机对照试验数量较少，且样本量较小，因此应谨慎对待这一结论，未来还需更多高质量和大样本的临床研究。

orcid:0000-0002-9127-8934(Jing He)

关键词: 针灸, 康复治疗, 儿童, 有效性, 安全性, 脑性瘫痪, 荟萃分析, 随机对照试验

Abstract:

OBJECTIVE: To evaluate the efficacy and safety of acupuncture therapy for children with cerebral palsy.
DATA SOURCES: We conducted electronic searches of PUBMED (1950/2017), EMBASE (1974/2017), ScienceDirect (1986/2017), Academic Source Premier (1887/2017), the Cochrane Library (Issue 4, April 2017), Science Citation Index Expanded (1900/2017), China National Knowledge Infrastructure (1915/2017), China Biological Medicine (1990/2017-04), WanFang (1980/2017), VIP (1989/2017), and Chinese Science Citation Database (1989/2017).
DATA SELECTION: We included randomized controlled trials that aimed to compare the effect of acupuncture plus rehabilitation training versus rehabilitation training alone. Data about functional motor abilities, daily activity/social participation, effective rate, intellectual development, and adverse effects were included. We used Revman 5.2 software for statistical analysis.
OUTCOME MEASURES: The primary outcomes included functional motor abilities, daily activity, and effective rate. The secondary outcomes included intellectual development and adverse effects.
RESULTS: Twenty-one studies with a total of 1 718 participants met the inclusion criteria. The effect size of gross motor function (SMD = 0.64, 95% CI: 0.52 to 0.76, P < 0.00001;  I2 = 0%, P = 0.69; in 13 studies with 1 144 patients) and the total effective rate (RR = 1.28, 95% CI: 1.20 to 1.37, P < 0.00001;  I2 = 18%, P = 0.27; in 12 studies with 1 106 patients) suggested that acupuncture plus rehabilitation produced a significant improvement in gross motor function and a high total effective rate. The pooled fine motor function (SMD = 3.48, 95% CI: 2.62 to 4.34, P < 0.00001;  I2 = 64%, P = 0.10; in 2 studies with 193 patients), modified Ashworth scale scores (SMD = –0.31, 95% CI: –0.52 to –0.11, P = 0.003;  I2 = 74%, P = 0.004; in 5 studies with 363 patients) and activities of daily living (SMD = 1.45, 95% CI: 1.20 to 1.71, P < 0.00001; I2 = 78%, P = 0.004; in 4 studies with 313 patients) also indicated improvements in children with cerebral palsy. Publication bias was not observed. Only mild adverse events related to acupuncture were reported.
CONCLUSION: Acupuncture plus rehabilitation training improved gross motor function, reduced muscle spasms, and enhanced daily life activities in children with cerebral palsy. However, this conclusion should be interpreted with caution due to the small number of randomized controlled trials available and the small sample sizes. More high-quality and large-scale studies are needed.

Key words: nerve regeneration, acupuncture, rehabilitation, children, efficacy, safety, cerebral palsy, meta-analysis, randomized controlled trials, neural regeneration