摘要
目的系统评价针灸与西药比较治疗帕金森病的有效性与安全性。方法计算机检索CBM(1979～2008)、CNK(I1979～2008)、VIP(1989～2008)、万方数字化期刊群(1998～2008)、PubMe(d1966～2008)、EMbase(1980～2008)和Cochrane Library(2008年第4期)数据库,并辅以手工检索,纳入针灸与西药比较治疗帕金森病的随机对照试验。由两名评价者独立提取资料并交叉核对,而后按照Cochrane系统评价员手册4.2.8进行质量评估,采用RevMan5.0.20软件进行Meta分析。结果共纳入13个随机对照试验,包括832例患者。Meta分析结果显示:①有效率:针灸或针灸+美多巴与单用美多巴比较,两组在Webster减分率方面差异均无统计学意义。针灸+美多巴与单用美多巴比较,两组UPDRS减分率在第30天[RR=1.33,95%CI(0.95,1.88)]、第66天[RR=1.38,95%CI(0.84,2.24)]时差异无统计学意义,但在第84天时差异有统计学意义[RR=1.61,95%CI(1.19,2.17)]。针灸+苄丝肼-左旋多巴与单用苄丝肼-左旋多巴比较,两组在第66天时有效率差异有统计学意义[RR=1.70,95%C(I1.08,2.68)]。②Webster评分:针灸与美多巴比较,两组在第30天、63天时差异有统计学意义[WMD=-2.51,95%CI(-2.83,-2.19);WMD=-2.48,95%CI(-3.01,-1.95)];针灸+美多巴与美多巴比较,两组在第30天时差异有统计学意义[WMD=-13.48,95%CI(-15.35,-11.61)],而在第42天时差异无统计学意义[WMD=0.50,95%CI(-1.22,2.22)]。③UPDRS评分:针灸与美多巴比较,两组在第60天时差异无统计学意义[WMD=-7.19,95%CI(-14.49,0.11)];针灸+美多巴与单用美多巴比较,两组在第30天、第84天时UPDRS评分差异均有统计学意义[WMD=7.07,95%CI(2.95,11.19);WMD=-12.49,95%CI(-16.75,-8.23)];但在第66天、33天时差异均无统计学意义[(WMD=-14.90,95%CI(-31.89,2.09);WMD=-8.60,95%CI(-21.51,4.31)];针灸+苄丝肼-左旋多巴与单用苄丝肼-左旋多巴比较,两组在第66天、33天差异均无统计学意义[WMD=-14.90,95%CI(-31.89,2.09);WMD=-8.60,95%CI(-21.51,4.31)]。④不良反应:3个试验报道了针灸可能有头晕、心跳加速、轻微口干、恶心等不良反应,但均能在治疗过程中缓解和消失。结论针灸治疗帕金森病安全、有效。针灸配合西药可能优于单用西药。但因纳入文献数量有限且部分研究质量较低,上述结论需更多高质量的随机对照试验来进一步验证。
Objective To assess the efficacy and safety of acupuncture versus western medicine in the treatment of parkinson disease.Methods Randomized controlled trials（RCTs） involving acupuncture versus western medicines in the treatment of parkinson disease were identified from CBM（1978 to 2008）,VIP（1989 to 2008）,Wanfang Database（1998 to 2008）,CNKI（1979 to 2008）,PubMed（1966 to 2008）,EMbase（1980 to 2008）,and The Cochrane Library（Issue 4,2008）.And some relevant journals were handsearched.Data were extracted and evaluated by two reviewers independently with a specially-designed extraction form.The Cochrane Collaboration＇s RevMan 5.0.20 software was used for metaanalyses.Results A total of 13 trials involving 832 patients were included.The result of meta-analyses showed that the total effective rates of the acupuncture group or of the group of acupuncture plus Madopar were similar when compared with Madopar alone in Webster score.（1） The total effective rate：The total effective rate in acupuncture plus Madopar was similar when compared with Madopar alone in UPDRS score at Day 30（RR=1.33,95%CI 0.95 to 1.88）and Day 66（RR=1.38,95%CI 0.84 to 2.24）,but there were significant differences between acupuncture plus Madopar and Madopar alone（RR=1.61,95%CI（1.19 to 2.17） at Day 84.The total effective rate in acupuncture plus benserazide-levodopa was higher than benserazide-levodopa alone（RR=1.70,95%CI 1.08 to 2.68） at Day 66.（2）Webster score：There were no sig-nificant differences between acupuncture and Madopar at Day 30（WMD=-2.51,95%CI-2.83 to-2.19）and at Day 63（WMD=-2.48,95%CI-3.01 to-1.95）.There were significant differences between acupuncture plus Madopar and Madopar alone at Day 30（WMD=-13.48,95%CI-15.35 to-11.61）,but not at Day 42（WMD=0.50,95%CI-1.22 to 2.22）.（3） UPDRS score：There were no significant differences between acupuncture and Madopar at Day 60（WMD=-7.19,95%CI-14.49 to 0.11）.There were significant differences between acupuncture plus Madopar and Madopar alone at Day 30（WMD= 7.07 and 95%CI 2.95 to 11.19） and at Day 84（WMD=-12.49,95%CI-16.75 to-8.23）,but no significant differences were found at Day 66 and Day 33（WMD=-14.90,95%CI-31.89 to 2.09;WMD=-8.60,95%CI-21.51 to 4.31）.But there were statistical differences between acupuncture plus Madopar and Madopar alone at Day 30（WMD= 7.07,95%CI 2.95 to 11.19）.There were no differences between acupuncture plus benserazide-levodopa and benserazidelevodopa alone at Day 66（WMD=-10.80,95%CI-21.78 to 0.18） and at Day 33（WMD=-15.60,95%CI-28.38 to-2.82）.（4）Adverse reaction：Three trials reported adverse reactions including dizziness,heartbeat acceleration,slight mouth drying and nausea,but all of these were relieved or disappeared in the course of treatment.Conclusion Acupuncture is safe and effective in the treatment of parkinson disease.Acupuncture plus western drugs may be superior to western drugs alone.Because of the defects in the methodological quality of the included trials,the conclusion is to be conf irmed by more highquality RCTs.
出处
《中国循证医学杂志》
CSCD
2010年第6期711-717,共7页
Chinese Journal of Evidence-based Medicine
基金
国家"十一五"科技支撑计划项目(No.2006BAI12B01)
关键词
针灸治疗
帕金森病
美多巴
卞丝肼-左旋多巴
随机对照试验
系统评价
Acupuncture treatment
Parkinson Disease
Madopar
Benserazide-levodopa
Randomized controlled trial
Systematic review
