针刺治疗儿童抽动障碍随机对照试验的Meta分析

发布时间：2018-12-30 12:55

【摘要】：目的:评价针刺治疗儿童抽动障碍(TD)的有效性及安全性。方法:检索Medline、Embase、CBM、CNKI等数据库自建库起发表的针刺治疗TD的随机对照试验(RCTs),进行文献筛选后,以Jadad评分量表进行质量评价,并采用Rev Man 5.3进行Meta分析。结果:共纳入29个RCTs,均为低质量文献,累计患儿2325例。Meta分析显示:针刺或联用常规西药相对于常规西药,均可提高临床总有效率[OR=2.94,95%CI(2.24,3.85),P0.000 01][OR=2.98,95%CI(1.53,5.82),P=0.001],减少耶鲁综合抽动严重程度量表(YGTSS)总评分[SMD=-1.29,95%CI(-1.87,-0.70),P0.000 1][SMD=-0.71,95%CI(-1.11,-0.32),P=0.000 4];针刺联合心理行为疗法降低YGTSS总评分优于常规西药联用心理行为疗法[SMD=-0.47,95%CI(-0.84,-0.11),P=0.01],而总有效率无统计学差异;针刺联用常规西药与心理行为疗法提高总有效率优于常规西药联用心理行为疗法[OR=2.11,95%CI(1.04,4.27),P=0.04],而YGTSS总评分无统计学差异。仅有2项研究报告了不良反应。结论:针刺可作为治疗儿童抽动障碍的单一疗法或常规治疗(常规西药及心理行为疗法)的辅助疗法,但因纳入研究的质量较低,部分亚组纳入文献数量较少,且存在发表、信息等偏倚的可能,使得上述结论仍需更多高质量、大样本、多中心随机对照试验进行验证。
[Abstract]:Objective: to evaluate the efficacy and safety of acupuncture in the treatment of children with tic disorder (TD). Methods: a random controlled trial of acupuncture for TD published from the database of Medline,Embase,CBM,CNKI and other databases was searched for literature screening. The quality was evaluated with Jadad score scale and Meta analysis was performed with Rev Man 5.3. Results: a total of 29 RCTs, were all of low quality literature, and 2325 cases of children were included. Meta analysis showed that acupuncture or combined use of conventional western medicine could improve the total clinical effective rate [OR=2.94,95%CI (2.240.85)]. P0.00001] [OR=2.98,95%CI (1.53 卤5.82), P0. 001], reducing the (YGTSS) total score of Yale Comprehensive tic severity scale [SMD=-1.29,95%CI (-1.87 卤0.70)], P0. 000 1] [SMD=-0.71,95%CI (-1.11 -0.32), P0. 000 4]; Acupuncture combined with psychobehavioral therapy reduced the total score of YGTSS better than that of routine western medicine combined with psychobehavioral therapy [SMD=-0.47,95%CI (-0.84- 0.11), P0.01], but the total effective rate had no statistical difference. The total effective rate of acupuncture combined with conventional western medicine and psychobehavioral therapy was better than that of routine western medicine combined with psychobehavioral therapy [OR=2.11,95%CI (1.044.27), P0. 04], but there was no statistical difference in total score of YGTSS. Only two studies reported adverse reactions. Conclusion: acupuncture can be used as a monotherapeutic or routine therapy for children with tic disorder (conventional western medicine and psycho-behavioral therapy). However, because of the low quality of the study, the number of literature included in some subgroups is relatively small and published. Due to the possibility of information equal-bias, the above conclusions still need to be verified by high quality, large sample and multicenter randomized controlled trials.
【作者单位】：中山大学附属第一医院;深圳市第二人民医院;
【基金】：中国博士后科学基金一等项目(2016M590840) 广东省科技计划项目(2014A020221003) 广东省中医药局科研项目(2016121)
【分类号】：R246.4

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