针刺治疗中风后中枢性疼痛的系统评价与Meta分析  

Acupuncture treatment for central post-stroke pain:a systematic review and meta-analysis

作　　者：程鑫妮 张欣 纪军 CHENG Xinni;ZHANG Xin;JI Jun(Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Shanghai Research Institute of Acupuncture and Meridian,Shanghai 200030,China)

机构地区：[1]Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China [2]Shanghai Research Institute of Acupuncture and Meridian,Shanghai 200030,China

出　　处：《Journal of Acupuncture and Tuina Science》2024年第4期341-352,共12页针灸推拿医学（英文版）

基　　金：上海市卫生健康委员会卫生行业临床研究专项青年项目,No.20204Y0252.

摘　　要：目的:评价针刺治疗中风后中枢性疼痛(CPSP)的有效性和安全性。方法:计算机检索PubMed、EMBASE、Cochrane Library、中国知网(CNKI)、万方数据知识服务平台(Wanfang)、维普资讯中文期刊服务平台(VIP)、中国生物医学文献数据库(CBM)中针刺治疗CPSP的随机对照试验文献。检索时间从建库至2023年7月。采用RevMan5.3软件进行meta分析;GRADEprofiler3.6.1软件进行证据质量评价。二分类资料采用相对危险度(RR)进行分析。连续性资料采用均数差(MD)进行分析,置信区间(CI)取95%进行计算。结果:纳入14篇文献,共1045例患者。Meta分析结果表明,与西药治疗CPSP相比,针刺治疗的临床有效率更高[RR=1.09,95%CI(1.01,1.19),Z=2.08,P<0.05]、疼痛视觉模拟量表(VAS)评分更低[MD=-0.75,95%CI(-1.18,-0.32),Z=3.41,P<0.001]、疼痛分级指数(PRI)评分更低[MD=-1.72,95%CI(-2.76,-0.68),Z=3.24,P<0.05]、血浆β-内啡肽(β-EP)水平更高[MD=5.81,95%CI(3.00,8.62),Z=4.05,P<0.001];不良反应发生率更低[RR=0.05,95%CI(0.01,0.18),Z=4.35,P<0.001]。现有疼痛强度(PPI)评分两者无统计学差异[MD=-0.26,95%CI(-0.54,0.02),Z=1.79,P>0.05]。与西药治疗CPSP比较,针刺+西药治疗的临床有效率更高[RR=1.18,95%CI(1.05,1.34),Z=2.75,P<0.05]、VAS评分更低[MD=-1.04,95%CI(-1.26,-0.82),Z=9.25,P<0.001]、匹兹堡睡眠质量指数(PSQI)评分更低[MD=-2.67,95%CI(-4.80,-0.54),Z=2.46,P<0.05]。证据质量等级评价结果显示针刺或针刺+西药与西药对比治疗CPSP均无中、高质量的证据。结论:针刺治疗CPSP较西药治疗有一定的疗效优势,能够有效缓解疼痛,改善睡眠,且出现不良反应较少,安全性较高,但仍需高质量的随机对照试验进一步研究与验证。Objective:To evaluate the efficacy and safety of acupuncture in the treatment of central post-stroke pain(CPSP).Methods:Randomized controlled trials of acupuncture treatment for CPSP in PubMed,Excerpta Medica Database(EMBASE),Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang Data Knowledge Service Platform(Wanfang),Chongqing VIP Database(VIP),and China Biology Medicine Disc(CBM)were retrieved by computer.The retrieval time was from each database’s inception to July 2023.Meta-analysis was performed using RevMan 5.3 software;GRADEprofiler 3.6.1 software was used to evaluate the quality of evidence.Dichotomous variables were analyzed by the risk ratio(RR).Continuous data were analyzed by mean difference(MD)with a confidence interval(CI)of 95%.Results:A total of 14 studies were included,comprising a total of 1045 patients.The findings of the meta-analysis showed that compared with Western medication in treating CPSP,the acupuncture treatment had a higher clinical effective rate[RR=1.09,95%CI(1.01,1.19),Z=2.08,P<0.05],a lower visual analog scale(VAS)score[MD=-0.75,95%CI(-1.18,-0.32),Z=3.41,P<0.001],a lower pain rating index(PRI)score[MD=-1.72,95%CI(-2.76,-0.68),Z=3.24,P<0.05],a higher plasmaβ-endorphin(β-EP)level[MD=5.81,95%CI(3.00,8.62),Z=4.05,P<0.001],and a lower adverse reaction rate[RR=0.05,95%CI(0.01,0.18),Z=4.35,P<0.001].There was no statistical difference in the present pain intensity(PPI)score between the two treatments[MD=-0.26,95%CI(-0.54,0.02),Z=1.79,P>0.05].Compared with Western medication in treating CPSP,acupuncture plus Western medication had a higher clinical effective rate[RR=1.18,95%CI(1.05,1.34),Z=2.75,P<0.05],a lower VAS score[MD=-1.04,95%CI(-1.26,-0.82),Z=9.25,P<0.001],and a lower Pittsburgh sleep quality index(PSQI)score[MD=-2.67,95%CI(-4.80,-0.54),Z=2.46,P<0.05].The results of the evidence quality grade evaluation showed that there was no moderate-or high-quality evidence for acupuncture or acupuncture plus Western medication compared with Western medication in the treat

关 键 词：针刺疗法 中风 中风后遗症 中枢性疼痛 META分析 系统评价 

分 类 号：R246.6[医药卫生—针灸推拿学]