基于脑功能磁共振成像系统评价针灸治疗缺血性脑卒中的疗效  

Systematic Evaluation of Clinical Effects of Acupuncture in the Treatment of Ischemic Stroke Based on Brain Functional Magnetic Resonance Imaging

作　　者：莫雨晓 陈楚云 张去飞 卢立宏 叶丽云 MO Yuxiao;CHEN Chuyun;ZHANG Qufei;LU Lihong;YE Liyun(The Affiliated TCM Hospital of Guangzhou Medical University,Guangzhou 510130,China)

机构地区：[1]广州医科大学附属中医医院,广东广州510130

出　　处：《西部中医药》2023年第5期61-67,共7页Western Journal of Traditional Chinese Medicine

基　　金：广东省自然科学基金(2014A030309013);全国中医药创新骨干人才培训项目(国中医药人教函[2019]128号);广东省科技计划项目(2017A030303004)。

摘　　要：目的:以脑功能磁共振成像(functional magnetic resonance imaging,fMRI)为观察指标,系统评价针灸治疗缺血性脑卒中(ischemic stroke,IS)的疗效。方法:计算机全面检索国内外期刊数据库,查找以fMRI成像为观察指标的针灸治疗IS随机对照实验(RCT),并追索纳入文献的参考文献,时间范围为建库日至2020年1月31日。由2名研究者根据纳入和排除标准分别独立筛选文献、提取资料,并通过Cochrane系统的偏移风险评估工具对纳入的研究进行方法学质量评价,再通过RevMan 5.2软件进行Meta分析。结果:最终纳入18篇RCT,共631例患者。18项研究均以fMRI成像作为观察指标,但因临床异质性过大,仅作描述性评价,结果显示针灸可引起缺血性脑卒中患者脑灰质结构改变、脑区局部一致性(ReHo)增高、脑区激活及脑区功能连接强度变化。次要结局指标Meta分析结果显示,针灸治疗IS临床疗效优于非针灸组,并可有效提高IS患者的Barthel指数及Fugl-Meyer肢体运动功能评分,可降低患者神经功能缺损评分。结论:目前证据显示,针灸治疗IS疗效显著,且可刺激脑区神经细胞生物活性,从而发生神经元活动改变,引起脑网络结构重组或脑区功能连接强度变化,使得受损神经功能可逆性恢复,或为针灸改善机体运动和认知功能的潜在治疗靶点和作用机制。Objective:To systematically assess the effects of acupuncture on ischemic stroke(IS)by taking brain fMRI as the outcome measures.Methods:Computer was used to retrieve from domestic and foreign journal databases comprehensively,to find out RCT about acupuncture in the treatment of IS by taking fMRI as the imaging index,and search for the reference in the included literature,and the time limit was between database establishment date and January 31,2020.Two searchers screened the literature and extracted the data according to the inclusion and exclusion criteria,methodological quality of the included researches was assessed by deviation risk assessment tool of Cochrane system,Meta analysis or system evaluation was carried out by RevMan 5.2 software.Results:Consequently,18 RCTs were included,aggregating 631 patients.fMRI imaging was used as the observed indicators in 18 studies,but due to the large clinical heterogeneity,only descriptive evaluation was made,and the results showed that acupuncture could cause the changes of gray matter structure,local consistency(ReHo)increase in brain area,activation or inhibition of brain area and changes in functional connectivity strengthen of brain areas.The results of Meta-analysis of secondary outcome indicators showed that clinical effects of acupuncture in the treatment of IS were better than these of non-acupuncture group,and the therapy could effectively increase Barthel index and Fugl-Meyer limb motor function scores effectively,and reduce NIHSS.Conclusion:Current evidence reveals that acupuncture could obtain significant effects in the treatment of IS,it could stimulate the biological activity of nerve cells in the brain area,thus,changing the activity of neurons,resulting in the reorganization of brain network structure or changes in the functional connection strength of brain areas,making the reversible recovery of the damaged nerve function,or as a potential therapeutic target and mechanism for acupuncture to improve the body’s motor and cognitive function.

关 键 词：缺血性脑卒中 脑功能磁共振成像 META分析 系统评价 随机对照实验 针灸 

分 类 号：R243[医药卫生—中医临床基础]