Objective: To systematically evaluate the efficacy and safety of thrombolysis combined with acupuncture therapy in the treatment of acute cerebral infarction (ACI) in the light of evidence-based medicine.
Methods: Randomized controlled trials (RCT) for acupuncture and thrombolysis treatment of acute cerebral infarction published from the inception of databa-ses to March 2020 were searched from PubMed, Cochrane Library, Embase, Web of science, CNKI, Wanfang, VIP, and CBM Database. According to the inclusion and exclusion criteria, two reviewers independently screened the RCTs and extracted the data. The quality of the included literature was evaluated, and the Meta-analysis was performed by using Revman 5.3 software.
Results: A total of 330 studies were identified, and 14 RCTs (including 604 cases of the treatment group, 598 cases of the control group) met the inclusion criteria. The Meta-analysis showed that the thrombolysis combined with acupuncture therapy was better than acupuncture therapy alone in the clinical effective rate (risk ratio ［RR］=1.19, 95% confidence interval ［CI］ ［1.13, 1.25］), NIHSS score (mean difference ［MD］=-3.51, 95% CI ［-4.54, -2.48］), BI index (MD=12.26, 95% CI ［8.07, 16.46］), and in lowering C-reaction protein levels (MD=-3.99, 95% CI ［-4.35, -3.63］). The rate of complete recanalization (RR = 1.20, 95% CI ［1.00, 1.44］), adverse reaction (RR = 0.76, 95% CI ［0.41, 1.41］) and hemorrhagic conversion (RR = 0.72, 95% CI ［0.14, 3.62］) was not statistically significant.
Conclusion: The current effective evidence shows that acupuncture has certain advantages in improving the therapeutic effect and safety of thrombolysis in the treatment of ACI patients.
目的：对针刺联合溶栓治疗急性脑梗死(ACI)的疗效及安全性进行系统评价。方法：检索PubMed、Cochrane Library、Embase、Web of Science、中国知网、万方、维普、中国生物医学文献数据库(CBM)中关于针刺联合溶栓治疗ACI 的临床随机对照试验, 检索时间为各库建库时间至2020年3月。由2名研究者根据纳入排除标准, 独立对文献进行筛选, 提取评估, 并使用Revman 5.3软件对数据进行Meta分析。结果：共纳入14项研究。Meta分析结果显示, 在常规溶栓基础上加入针刺治疗可提高ACI 患者的临床有效率(RR=1.19, 95% CI ［1.13, 1.25］), 降低美国国立卫生研究院卒中量表评分(MD=-3.51, 95% CI ［-4.54, -2.48］),改善Barthel指数(MD=12.26, 95% CI ［8.07, 16.46］), 并降低C反应蛋白水平(MD=-3.99, 95% CI ［-4.35, -3.63］)。两组间血管完全再通率(RR=1.20, 95% CI ［1.00, 1.44］)、不良反应率(RR=0.76, 95% CI ［0.41, 1.41］)和出血性转化率(RR=0.72, 95% CI ［0.14, 3.62］)均差异无统计学意义。结论：当前有效证据表明, 针刺在提高ACI溶栓的治疗效果及安全性方面具有一定的优势。.
Keywords: Acupuncture; Acute cerebral infarction; Meta-analysis; Thrombolysis; stroke.