针刺联合常规西药治疗轻度认知功能障碍的系统评价和Meta分析

Systematic review and Meta-analysis of acupuncture combined with conventional western medicine in the treatment of mild cognitive impairment

摘要

目的 系统评价针刺联合常规西药治疗轻度认知功能障碍的安全性和有效性。方法 检索国家知识基础设施数据库 (CNKI)、中国生物医学文献数据库 (CBM)、中国学术期刊数据库 (CSPD)、中文科技期刊数据库 (CCD) 及 PubMed、The Cochrane Library、Embase 医学文献数据库, 收集从建库至 2024 年 9 月 30 日发表的有关针刺联合常规西药治疗为主要干预措施治疗轻度认知功能障碍的随机对照试验。由两名研究者对检索到的文献进行独立筛选、资料提取, 并根据 Cochrane Handbook 偏倚风险评估工具对纳入文献质量评价后, 采用 Review Manager 5.4 软件进行 Meta 分析。结果 共纳入 13 篇文献, 合计 916 例轻度认知功能障碍患者。Meta 分析结果显示, 观察组在临床总有效率 (RR=1.40, 95%CI: 1.28~1.52, P<0.00001) 及干预后简易精神状态量表 (MMSE) 评分 (MD=1.79, 95%CI: 1.11~2.48, P<0.00001)、蒙特利尔认知评估量表 (MoCA) 评分 (MD=2.15, 95%CI: 1.47~2.83, P<0.00001)、日常生活能力量表 (ADL) 评分 (MD=5.32, 95%CI: 2.35~8.28, P=0.0004) 改善方面均优于对照组, 差异有统计学意义。亚组分析结果显示, 在 MMSE、MoCA 评分的改善程度上, 针刺联合尼莫地平与单用尼莫地平比较, 差异均无统计学意义 (P>0.05); 在 ADL 评分的改善程度上, 针刺联合多奈哌齐与单用多奈哌齐比较, 差异无统计学意义 (P>0.05)。结论 针刺联合常规西药治疗能有效改善轻度认知功能障碍患者的认知功能和日常生活能力, 且疗效优于单纯西药治疗, 安全性高, 不良反应较少。但受限于纳入文献的质量和数量, 未来仍需要更多大样本、多中心、高质量的随机对照试验进一步验证针刺联合常规西药治疗对轻度认知功能障碍患者的临床应用效果。

Abstract

Objective To systematically evaluate the safety and effectiveness of acupuncture combined with conventional western medicine in the treatment of mild cognitive impairment. Methods The China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), China Science Periodical Database (CSPD), China Citation Database (CCD) and PubMed, The Cochrane Library, Embase Medical Literature Database were searched to collect randomized controlled trials published from the establishment of the database to September 30, 2024 in which acupuncture combined with conventional western medicine treatment was the main intervention for the treatment of mild cognitive impairment. Two investigators independently screened and extracted the retrieved literature, evaluated the quality of the included literature according to the Cochrane Handbook Bias Risk Assessment Tool, and then used Review Manager 5.4 software to conduct Meta-analysis. Results A total of 13 articles were included, involving a total of 916 patients with mild cognitive impairment. Meta-analysis results showed that the total clinical effective rate in the observation group (RR=1.40, 95%CI: 1.28 to 1.52, P<0.00001) and mini-mental state examination (MMSE) scores after intervention (MD=1.79, 95%CI: 1.11 to 2.48, P<0.00001), Montreal cognitive assessment (MoCA) score (MD=2.15, 95%CI: 1.47 to 2.83, P<0.00001) and activities of daily living (ADL) score (MD=5.32, 95%CI: 2.35 to 8.28, P=0.0004) were better than the control group, and the difference was statistically significant. The results of subgroup analysis showed that there was no statistical difference in the improvement of MMSE and MoCA scores between acupuncture combined with nimodipine and nimodipine alone (P>0.05); In the improvement of ADL scores, there was no statistical difference between acupuncture combined with donepezil and donepezil alone (P>0.05). Conclusion Acupuncture combined with conventional western medicine can effectively improve the cognitive function and daily living abilities of patients with mild cognitive impairment, and the efficacy is better than that of western medicine alone. It has high safety and fewer adverse reactions. However, limited by the quality and quantity of included literature, more large-sample, multi-center, high-quality randomized controlled trials are still needed in the future to further verify the clinical application effect of acupuncture combined with conventional western medicine treatment in patients with mild cognitive impairment.

关键词

针刺 / 轻度认知功能障碍 / 系统评价 / Meta分析

Key words

Acupuncture / Mild cognitive impairment / Systematic review / Meta-analysis

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基金资助

^*国家重点研发计划(2018YFC1704106)

北京市自然科学基金面上项目(7232291)

北京市中医药管理局中医药质量控制管理项目(BJZYY202311)

北京市中医药管理局中医药质量控制管理项目(BJZYY202411)

北京中医药大学孙思邈研究院资助项目(SSMYJY-2-2021-12)