中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2026, Vol. 21 ›› Issue (3): 1191-1210.doi: 10.4103/NRR.NRR-D-24-01030

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

电针治疗缺血性脑卒中： 基于临床前研究的系统综述

  

  • 出版日期:2026-03-15 发布日期:2025-07-05
  • 基金资助:
    本研究得到国家自然科学基金（82174496、82374574、82302865）；上海市科委扬帆计划（）23YF1403800、23YF1405200）；上海市医院发展中心基金-上海市市立医院康复医学专科联盟（SHDC22023304）。

Electroacupuncture for the treatment of ischemic stroke: A preclinical meta-analysis and systematic review

Guohui Yang1, 2, #, Chong Guan1, 3, #, Meixi Liu1, 4, #, Yi Lin1, 4, Ying Xing5, 6, Yashuo Feng3 , Haozheng Li1, 4, Yi Wu1, 4, *, Nianhong Wang1, 4, *, Lu Luo1, 4, *   

  1. 1 Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China;  2 School of Exercise and Health, Shanghai University of Sport, Shanghai, China;  3 School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China;  4 National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China;  5 Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China;  6 Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China
  • Online:2026-03-15 Published:2025-07-05
  • Contact: Yi Wu, PhD, MD, wuyi@fudan.edu.cn; Nianhong Wang, PhD, wnh@fudan.edu.cn; Lu Luo, PhD, 19111220104@fudan.edu.cn.
  • Supported by:
    This study was supported by the National Natural Science Foundation of China, Nos. 82174496 (to NW), 82374574 (to NW), 82302865 (to LL); Shanghai Science and Technology Committee Sailing Program, Nos. 23YF1403800 (to LL), 23YF1405200 (to YX); Shanghai Hospital Development Center Foundation—Shanghai Municipal Hospital Rehabilitation Medicine Specialty Alliance, No. SHDC22023304 (to YW).

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摘要：

脑卒中是全球死亡和残疾的主要原因之一，而电针在脑卒中治疗中的应用由来已久。这项系统综述旨在评估电针在缺血性脑卒中动物模型中的疗效并探索其潜在机制。截至 2024-05-01，文章在 PubMed、EMBASE、Web of Science、CENTRAL 和 CINAHL 数据库中进行了全面的文献检索。纳入的研究都是关于电针治疗缺血性脑卒中的疗效和机制的临床前研究。文章使用 Stata 18.0 分析了 70 项符合条件的临床前研究数据，并使用随机效应模型计算了标准化平均差(Hedge's g)，同时使用 RevMan 5.4 软件评估了偏倚风险，并使用建议、评估、发展和评价分级(GRADE)系统对证据质量进行了评级。进行了分组分析以检验结果的一致性，并进行了敏感性分析以评估结果的稳健性。质量评估显示，大多数研究都充分处理了不完整数据和选择性报告，但也发现了方法学方面的局限性：只有 4 项研究显示分配隐藏的风险较低，26 项研究的结果评估盲法风险较低，9 项研究的随机化偏倚风险较高，受试者盲法和其他方法学方面的风险不明确。GRADE 评估将 12 项结果评为中等质量，6 项为低质量。电针治疗缺血性卒中的机制可归纳为5个主要途径：(1)电针可显著减少缺血性卒中模型的梗死体积和凋亡细胞(P < 0.01)；(2)电针还可显著减少促炎因子的表达(P < 0.01)，同时增加抗炎因子的表达(P=0.02)；(3) 电针可降低氧化应激指标水平(P < 0.01)，增强抗氧化酶的表达(P < 0.01)；(4)电针可显著促进神经再生(P < 0.01)；(5)电针可促进血流重塑和血管生成(P < 0.01)。亚组分析发现，电针在一过性大脑中动脉闭塞(tMCAO)模型(P < 0.01)和MCAO后干预(P < 0.01)中更为有效。在波形方面，分散波在神经保护和抗炎作用方面优于连续波(P < 0.01)，而头皮穴位的疗效高于体表穴位(P < 0.01)。纳入研究的异质性较小，敏感性分析表明结果稳定。纳入研究的方法质量大多令人满意。总之，电针可通过调节细胞凋亡、氧化应激、炎症、脑卒中诱导的神经再生、血流重塑和血管生成来有效治疗缺血性脑卒中。电针的疗效可能受 MCAO 模型、干预开始时间、波形和穴位选择等因素的影响。尽管此研究的GRADE证据质量为中低级别，但这些发现表明了电针在改善缺血性脑卒中疗效方面具有临床潜力。

https://orcid.org/0000-0002-4955-3533 (Yi Wu); https://orcid.org/0000-0002-3482-7327 (Nianhong Wang);

https://orcid.org/0000-0001-7670-0773 (Lu Luo)

关键词: 细胞凋亡, 血管生成, 电针, 缺血性脑卒中, 炎症, 荟萃分析, 神经再生, 氧化应激, 随机对照试验, 系统综述

Abstract: Stroke remains a leading cause of death and disability worldwide, and electroacupuncture has a long history of use in stroke treatment. This meta-analysis and systematic review aimed to evaluate the efficacy of electroacupuncture and explore its potential mechanisms in animal models of ischemic stroke. The PubMed, EMBASE, Web of Science, CENTRAL, and CINAHL databases were comprehensively searched up to May 1, 2024. This review included articles on preclinical investigations of the efficacy and mechanisms of electroacupuncture in treating ischemic stroke. Data from 70 eligible studies were analyzed in Stata 18.0, using a random-effects model to calculate the standardized mean difference (Hedge’s g). The risk of bias was assessed using RevMan 5.4 software, and the quality of evidence was rated according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Subgroup analyses were conducted to test the consistency of the results and sensitivity analyses were used to assess their robustness. The quality assessment revealed that most studies adequately handled incomplete data and selective reporting. However, several methodological limitations were identified: only 4 studies demonstrated a low risk of allocation concealment, 26 achieved a low risk of outcome assessment bias, and 9 had a high risk of randomization bias. Additionally, there was an unclear risk regarding participant blinding and other methodological aspects. The GRADE assessment rated 12 outcomes as moderate quality and 6 as low quality. The mechanisms of electroacupuncture treatment for ischemic stroke can be categorized as five primary pathways: (1) Electroacupuncture significantly reduced infarct volume and apoptotic cell death (P < 0.01) in ischemic stroke models; (2) electroacupuncture significantly decreased the levels of pro-inflammatory factors (P < 0.01) while increasing the levels of anti-inflammatory factors (P = 0.02); (3) electroacupuncture reduced the levels of oxidative stress indicators (P < 0.01) and enhanced the expression of antioxidant enzymes (P < 0.01); (4) electroacupuncture significantly promoted nerve regeneration (P < 0.01); and (5) electroacupuncture influenced blood flow remodeling (P < 0.01) and angiogenesis (P < 0.01). Subgroup analyses indicated that electroacupuncture was most effective in the transient middle cerebral artery occlusion model (P < 0.01) and in post-middle cerebral artery occlusion intervention (P < 0.01). Dispersive waves were found to outperform continuous waves with respect to neuroprotection and anti-inflammatory effects (P < 0.01), while scalp acupoints demonstrated greater efficacy than body acupoints (P < 0.01). The heterogeneity among the included studies was minimal, and sensitivity analyses indicated stable results. Their methodological quality was generally satisfactory. In conclusion, electroacupuncture is effective in treating cerebral ischemia by modulating cell apoptosis, oxidative stress, inflammation, stroke-induced nerve regeneration, blood flow remodeling, and angiogenesis. The efficacy of electroacupuncture may be influenced by factors such as the middle cerebral artery occlusion model, the timing of intervention onset, waveform, and acupoint selection. Despite the moderate to low quality of evidence, these findings suggest that electroacupuncture has clinical potential for improving outcomes in ischemic stroke.

Key words: apoptosis, angiogenesis, electroacupuncture, ischemic stroke, inflammation, metaanalysis, nerve regeneration, oxidative stress, randomized controlled trial, systematic review