头部针刺联合Schuell’s言语康复疗法治疗中风后失语症：23项随机对照试验的系统评价与meta分析

Qin-wei FU; Miao LIU; Lan-zhi ZHANG; Hui YANG; Le-qi ZHANG; Sha-sha YANG; Yan XIE; Xin-xin WAN; Yong TANG; Qin-xiu ZHANG

doi:10.1007/s11655-022-3722-5

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头部针刺联合Schuell’s言语康复疗法治疗中风后失语症：23项随机对照试验的系统评价与meta分析

Evidence-Based Integrative Medicine | Updated：2022-07-20

- 头部针刺联合Schuell’s言语康复疗法治疗中风后失语症：23项随机对照试验的系统评价与meta分析
- Head Acupuncture Plus Schuell's Language Rehabilitation for Post-Stroke Aphasia: A Systematic Review and Meta-Analysis of 32 Randomized Controlled Trials
- Chinese Journal of Integrative Medicine 2022年28卷第8期页码：743-752
- Affiliations：
  
  1.Department of Otolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu (610075), China
  2.Department of Gastroenterology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu (610075), China
  3.Department of Medical Cosmetology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu (610075),China
  4.Department of Endocrinology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu (610075),China
  5.OCD Institute, McLean Hospital, Boston (02346), USA
  6.Mental Health Counseling, Lynch School of Education, Boston College, Boston (02346), USA
  7.Department of Otolaryngology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang (550005), China
  8.Sydney School of Education and Social Work, The University of Sydney, Sydney (2006), Australia
  9.Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu (610075), China
  10.School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu (611137), China
  11.World Health Organization Collaborating Centre (WHOCC)-CHN-56, Chengdu (611137), China
- Author bio：
  
  Prof. ZHANG Qin-xiu, E-mail: zhqinxiu@163.com
- Funds：
  
  Xinglin Scholars Scientific Research Promotion Plan of Chengdu University of Traditional Chinese Medicine-Innovation Team of Traditional Chinese Medicine Otorhinolaryngology Discipline, Natural Science(XKTD2021003)
- DOI：10.1007/s11655-022-3722-5
  中图分类号：
- 纸质出版日期：2022-08，
  
  录用日期：2022-04-14
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Qin-wei FU, Miao LIU, Lan-zhi ZHANG, 等. 头部针刺联合Schuell’s言语康复疗法治疗中风后失语症：23项随机对照试验的系统评价与meta分析[J]. Chinese Journal of Integrative Medicine, 2022,28(8):743-752.

Qin-wei FU, Miao LIU, Lan-zhi ZHANG, et al. Head Acupuncture Plus Schuell's Language Rehabilitation for Post-Stroke Aphasia: A Systematic Review and Meta-Analysis of 32 Randomized Controlled Trials[J]. Chinese Journal of Integrative Medicine, 2022,28(8):743-752.
Qin-wei FU, Miao LIU, Lan-zhi ZHANG, 等. 头部针刺联合Schuell’s言语康复疗法治疗中风后失语症：23项随机对照试验的系统评价与meta分析[J]. Chinese Journal of Integrative Medicine, 2022,28(8):743-752. DOI： 10.1007/s11655-022-3722-5.

Qin-wei FU, Miao LIU, Lan-zhi ZHANG, et al. Head Acupuncture Plus Schuell's Language Rehabilitation for Post-Stroke Aphasia: A Systematic Review and Meta-Analysis of 32 Randomized Controlled Trials[J]. Chinese Journal of Integrative Medicine, 2022,28(8):743-752. DOI： 10.1007/s11655-022-3722-5.

摘要

目的:

通过评价现有随机对照试验 (RCT) 以研究头部针刺联合Schuell’s言语康复疗法治疗中风后失语症的有效性与安全性证据.

方法:

截止2021年11月14日

检索了3个英文数据库和4个中文数据库以获取相关RCT. 纳入标准中

试验组干预措施为头部针刺联合Schuell’s言语康复疗法

同时符合假干预 (或空白对照) 、单纯针刺疗法、单纯言语康复疗法

或单独使用其它对照干预措施的RCT被纳入. 在对数据进行提取、评估

并评价纳入RCT质量后

使用固定效应模型进行分析. 依次使用meta影响性分析、meta回归分析、基于回归的亚组分析以解释结果的异质性. 使用树状图和Egger’s检验检测结果的发表偏倚.

结果:

共纳入32项RCT

包含1968位中风后失语症者. 基于不同中风种类与失语症类型

共划分并分析比较组51组

结果显示: (1) 对于缺血性中风后失语症患者

头部针刺联合Schuell’s言语康复疗法显著提高了累积显效率[风险比 (RR) =1.55

95%置信区间 (CI) : 1.19-2.02

(异质性)

=0%]和累积有效率 (RR=1.22

95% CI: 1.36-1.72

=0%) ; (2) 对于综合种类中风后失语症患者

头部针刺联合Schuell’s言语康复疗法显著提高了治愈率 (RR=1.89

95% CI: 1.39-2.56

=0%) 、累积显效率 (RR=1.53

95% CI: 1.36-1.72

=9%) 和累积有效率 (RR=1.14

95% CI: 1.09-1.19

=34%) ; (3) 对于中风后运动性失语症患者

头部针刺联合Schuell’s言语康复疗法显著提高了治愈率 (RR=2.08

95% CI: 1.24-3.46

=0%) 、累积显效率 (RR=1.49

95% CI: 1.24-1.78

=0%) 和累积有效率 (RR=1.15

95% CI: 1.06-1.24

=39%) ; (4) 对于中风后综合类型失语症患者

头部针刺联合Schuell’s言语康复疗法显著提高了治愈率 (RR=1.86

95% CI: 1.28-2.72

=0%) 、累积显效率 (RR=1.55

95% CI: 1.35-1.78

=22%) 和累积有效率 (RR=1.17

95% CI: 1.11-1.23

=41%) ; (5) 对于缺血性中风后运动性失语症患者

头部针刺联合Schuell’s言语康复疗法显著提高了累积显效率 (RR=1.38

95% CI: 1.06-1.79

=0%) 和累积有效率 (RR=1.20

95% CI: 1.05-1.37

=0%) . Meta回归分析结果显示试验组干预措施有效性并未随疾病、干预措施特征改变而变化.

结论:

对于中风后失语症患者

头部针刺联合Schuell’s言语康复疗法可显著改善言语能力

提高治疗有效率. 头部针刺操作应谨慎

尤其当穴区在眼部、颈项部时.

Abstract

Objective:

To evaluate the existing randomized controlled trials (RCTs) for evidence of the efficacy and safety of head acupuncture (HA) plus Schuell's language rehabilitation (SLR) in post-stroke aphasia.

Methods:

Seven databases including Embase

PubMed

Cochrane Library

Technology Periodical Database

the China National Knowledge Infrastructure

SinoMed and Wanfang Data Information Site were searched for RCTs published from database inception until November 14

2021. RCTs that compared HA plus SLR with sham (or blank) control

acupuncture therapy alone

certain language rehabilitation therapy alone or other therapies for post-stroke aphasia were included. Data were extracted and assessed

and the quality of RCTs was evaluated. Fixed-effects model was used

with meta-influence analysis

meta-regression

and regression-based sub-group analyses applied for exploration of heterogeneity. Publication bias was estimated by funnel plots and Egger's tests.

Results:

A total of 32 RCTs with 1

968 patients were included and 51 comparisons were conducted classified as types of strokes and aphasia. (1) For patients with aphasia after ischemic stroke

HA plus PSA showed significantly higher accumulative markedly effective rate [relative risk (RR)=1.55

95% confidence interval (CI): 1.19–2.02

=0%] and accumulative effective rate (RR=1.22

95% CI: 1.09–1.36

=0%). (2) For patients with comprehensive types of stroke

HA plus PSA was more effective in increasing recovery rate (RR=1.89

95% CI: 1.39–2.56

=0%)

accumulative markedly effective rate (RR=1.53

95% CI: 1.36-1.72

=9%) and accumulative effective rate (RR=1.14

95% CI: 1.09-1.19

=34%). (3) For patients with aphasia after stroke

HA plus PSA was superior to PSA alone with statistical significance in increasing recovery rate (RR=2.08

95% CI: 1.24–3.46

=0%)

accumulative markedly effective rate (RR=1.49

95% CI: 1.24–1.78

=0%) and accumulative effective rate (RR=1.15

95% CI: 1.06–1.24

I 2=39%). (4) For patients with multiple types of aphasia

HA plus PSA also demonstrated significantly higher recovery rate (RR=1.86

95% CI: 1.28–2.72

=0%)

accumulative markedly effective rate (RR=1.55

95% CI: 1.35–1.78

=22%)

and accumulative effective rate (RR=1.17

95% CI: 1.11–1.23

=41%). (5) For patients with motor aphasia after ischemic stroke

compared with PSA alone

HA plus PSA showed significantly higher accumulative markedly effective rate (RR=1.38

95% CI: 1.06–1.79

=0%) and accumulative effective rate (RR=1.20

95% CI: 1.05–1.37

=0%). Meta-regression analyses were performed without significant difference

and publication bias was found in some comparisons.

Conclusion:

HA plus SLR was significantly associated with better language ability and higher effective rate for patients with post-stroke aphasia

and HA should be operated cautiously especially during acupuncture at eye and neck. (Registration No. CRD42020154475)

关键词

Keywords

language rehabilitationhead acupuncturestrokeaphasiasystematic reviewmeta-analysis

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