温针灸疗法与常规针刺治疗周围性面瘫的META分析（英文）
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摘要
目的:评价温针灸疗法对比常规针刺治疗周围性面瘫的临床疗效,探寻针灸治疗周围性面瘫有效简便方法。方法:计算机检索Pubmed(1979-2017年)、中国知网数据库(CNKI, 1979-2017年)、万方数据库(1990-2017年)、维普全文期刊数据库(VIP, 1989-2017年),收集温针灸疗法治疗周围性面瘫的随机对照试验,选择符合纳入标准的临床试验,以Cochrane5.0系统评价手册进行质量评价,统计学分析采用RevMan5.3.5。结果:23篇文献符合纳入标准,共1756例患者。(1)11篇文献的meta分析结果提示:温针灸疗法治疗周围性面瘫的总有效率高于常规针刺[RR=1.18, 95%CI(1.11, 1.25), P<0.00001]。(2)7篇文献的meta分析表明,温针灸疗法配合电针治疗周围性面瘫的总有效率高于电针[RR=1.15,95%CI(1.09,1.21),P<0.00001]。(3)5篇文献的meta分析显示,温针灸疗法配合其他疗法治疗周围性面瘫的总有效率高于常规针刺配合其他疗法[RR=1.08,95%可信区间(1.03, 1.14),P=0.002)。(4)5篇文献的meta分析显示,温针灸疗法可以改善周围性面瘫患者的House-Brackmann(H-B)分数,优于常规针刺[mean difference(MD)=-2.85, 95%CI(-5.08,-0.62), Z=2.51, P=0.01],表明温针灸疗法可以显著改善病人的面部神经功能。纳入的研究中未报告不良事件。纳入研究的方法学质量普遍较低。Meta分析显示温针灸疗法治疗周围性面瘫对比常规针刺,组间比较差异有统计学意义(P<0.01)。结论:温针灸疗法治疗周围性面瘫对照常规针刺可能有一定的优势,但因纳入文献数量有限且质量较低,结论尚不确定,需高质量证据来进一步验证。
Objective: The goal of this study is to explore effective treatments for peripheral facial paralysis and to evaluate the clinical efficacies of warm needling therapy and acupuncture in peripheral facial paralysis.Methods: PubMed(1979-2017), the Chinese National Knowledge Infrastructure database(CNKI, 1979-2017), Wanfang databases(1990-2017), and the Chongqing VIP full-text periodical database(VIP, 1989-2017) were searched by computer. Randomized controlled trials of warm needling therapy and acupuncture in the treatment of peripheral facial paralysis were collected. The clinical trials that met the inclusion criteria were selected for quality assessment using the Cochrane 5.0 Handbook for systematic evaluation.RevMan5.3 was used for statistical analysis.Results: A total of 23 articles with 1756 patients met the inclusion criteria.(1) The meta-analysis of 11 articles showed that the total effective rate of warm needling therapy for peripheral facial paralysis was higher than that of acupuncture [RR = 1.18, 95% Cl(1.11,1.25), P< 0.00001].(2) The meta-analysis of 7 articles showed that the total effective rate of warm needling therapy combined with electroacupuncture in the treatment of peripheral facial paralysis was higher than that of acupuncture combined with electroacupuncture [RR= 1.15, 95% Cl(1.09, 1.21), P< 0.00001].(3) The meta-analysis of 5 articles showed that the total effective rate of warm needling therapy combined with other therapies in the treatment of peripheral facial paralysis was higher than that of acupuncture combined with other therapies [RR= 1.08,95% Cl(1.03, 1.14), P=0.002].(4) The meta-analysis of 5 articles showed that warm needling therapy could improve the House-Brackmann(H-B) scores of patients with peripheral facial paralysis more than acupuncture [mean difference(MD)=-2.85, 95% Cl(-5.08,-0.62), Z = 2.51, P = 0.01], indicating that warm needling therapy provides superior improvement in the function of facial nerve innervation in the patients. No adverse events were reported in the included studies. The methodological quality of the included studies was generally low.Conclusion: The results of this meta-analysis showed that warm needling therapy is superior to acupuncture in treating peripheral facial paralysis, providing a therapeutic option for the treatment of peripheral facial paralysis. However, due to the small sample size and the low quality of the included studies, the above conclusion still needs to be validated with high-quality, large-scale, randomized, blinded controlled trials.
Objective: The goal of this study is to explore effective treatments for peripheral facial paralysis and to evaluate the clinical efficacies of warm needling therapy and acupuncture in peripheral facial paralysis.Methods: PubMed(1979-2017), the Chinese National Knowledge Infrastructure database(CNKI, 1979-2017), Wanfang databases(1990-2017), and the Chongqing VIP full-text periodical database(VIP, 1989-2017) were searched by computer. Randomized controlled trials of warm needling therapy and acupuncture in the treatment of peripheral facial paralysis were collected. The clinical trials that met the inclusion criteria were selected for quality assessment using the Cochrane 5.0 Handbook for systematic evaluation.RevMan5.3 was used for statistical analysis.Results: A total of 23 articles with 1756 patients met the inclusion criteria.(1) The meta-analysis of 11 articles showed that the total effective rate of warm needling therapy for peripheral facial paralysis was higher than that of acupuncture [RR = 1.18, 95% Cl(1.11,1.25), P< 0.00001].(2) The meta-analysis of 7 articles showed that the total effective rate of warm needling therapy combined with electroacupuncture in the treatment of peripheral facial paralysis was higher than that of acupuncture combined with electroacupuncture [RR= 1.15, 95% Cl(1.09, 1.21), P< 0.00001].(3) The meta-analysis of 5 articles showed that the total effective rate of warm needling therapy combined with other therapies in the treatment of peripheral facial paralysis was higher than that of acupuncture combined with other therapies [RR= 1.08,95% Cl(1.03, 1.14), P=0.002].(4) The meta-analysis of 5 articles showed that warm needling therapy could improve the House-Brackmann(H-B) scores of patients with peripheral facial paralysis more than acupuncture [mean difference(MD)=-2.85, 95% Cl(-5.08,-0.62), Z = 2.51, P = 0.01], indicating that warm needling therapy provides superior improvement in the function of facial nerve innervation in the patients. No adverse events were reported in the included studies. The methodological quality of the included studies was generally low.Conclusion: The results of this meta-analysis showed that warm needling therapy is superior to acupuncture in treating peripheral facial paralysis, providing a therapeutic option for the treatment of peripheral facial paralysis. However, due to the small sample size and the low quality of the included studies, the above conclusion still needs to be validated with high-quality, large-scale, randomized, blinded controlled trials.
引文
[1] Wu H. Kan H. Li C, et al. Effect of acupuncture on functional connectivity of anterior cingulate cortex for Bell's palsy patients with different clinical duration. Evid Based Complement Alternat Med 2015;2015:646872.
[2] McCaul JA, Cascarini L, Godden D, Coombes D, Brennan PA, Kerawala CJ.Evidence based management of Bell's palsy. Br J Oral Maxillofac Surg2014;52:387-91.
[3] Mooney T. Diagnosis and management of patients with Bell's palsy. Nurs Stand2013;28:44-9.
[4] Li P, Qiu T, Chao Q. Efficacy of Acupuncture for Bell's palsy:a systematic review and meta-analysis of randomized controlled trials. PLoS ONE2015;10(5):e0121880.
[5] Fabrin S, Soares N, et al. The effects of acupuncture on peripheral facial palsy sequelae after 20 years via electromyography. J Acupunct Meridian Stud2015;8:245-8. doi:10.1016/ijams.2015.01.006.
[6] Lee J, Yang J, Li CF, et al. Cortical reorganization in patients recovered from Bell's palsy:an orofacial and finger movements task-state fMRI study. Neural Plast 2016;2016:8231726. doi:10.1155/2016/8231726.
[7] Zhang CY, Xu SB, Huang B, et al. Needle sensation and personality factors influence therapeutic effect of acupuncture for treating Bell's palsy:a secondary analysis of a multicenter randomized controlled trial. Chin Med J2016;129:1789-94. doi:10.4103/0366-6999.186640.
[8] Kim Jl,Lee MS, Choi TY, et al. Acupuncture for Bell's palsy:a systematic review and meta-analysis. Chin J Integr Med 2012;18(1):48-55.
[9] Chen N, Zhou M, He L, et al. Acupuncture for Bell's palsy. Cochrane Database Syst Rev 2010;8:CD002914. doi:10.1002/14651858.CD002914,pub5.
[10] Li C, Yang J, Sun J, et al. Brain responses to acupuncture are probably dependent on the brain functional status. Evid Based Complement Alternat Med2013;2013:175278.
[11] He X, Zhu Y, Li C, et al. Acupuncture-induced changes in functional connectivity of the primary somatosensory cortex varied with pathological stages of Bell's palsy. Neuroreport 2014;25(14):1162-8.
[12] Bian Y, He X. Hu S, et al. Functional connectivity modulation by acupuncture in patients with Bell's palsy. Evid Based Complement Alternat Med 2016:2016:5928758.
[13] Park SU. Cho SY, Park JM, et al. Integrative treatment modalities for stoke victims in Korea. Complement Ther Clin Pract 2014;20:37-41.
[14] Sun ZR, Yue JH, Zhang QH. Electroacupuncture at Jing-jiaji points for neck pain caused by cervical spondylosis:a study protocol for a randomized controlled pilot trial. Trials 2013:14:360.
[15] Zhang SN, Chen G, Xiang J. To observe the clinical efficacy of warm needling moxibustion plus flash cupping for remission-stage peripheral facial paralysis(FP)due to wind-cold. J Acupunct Tuina Sci 2017;15:42-6.
[16] Sun HC. The clinical observation on acute peripheral facial palsy by warm needling therapy conbined with syndrome differentiation of chinese medicine.Lishizhen Med and Materia Medica Res 2015;26:1175-6. doi:10.3969/j.issn.1008-0805.2015.05.056.
[17] Jing YF. The clinical effects observation of 50 cases on acute peripheral facial palsy by warm acupuncture therapy. For all Health 2017;11:24-5.
[18] Li W. The clinical effects observation on acute peripheral facial palsy by warm acupuncture therapy. Nei Mongol J Tradit Chin Med 2017;36:123-4[2017-08-18]. doi:10.16040/j.cnki.cnl5-1101.2017.03.113.
[19] Zheng MH, Ye T, Wang GW. Clinical effect on peripheral facial paralysis with wind cold type by warm acupuncture therapy. J Clin Acupunct Moxibustion2016;32:58-60.
[20] Deng SB, Tang ZY. Clinical effect for warm acupuncture therapy on Zu San Li(ST36)points of peripheral facial paralysis with wind cold type. Med Hyg2016; 1:40.
[21] Guo Q. The effects on peripheral facial paralysis with wind cold type by warm needling therapy contrasted with acupuncture. World Latest Med Inf(Electron Version)2015;15:86. doi:10.3969/j.issn.1671-3141.2015.76.073.
[22] Tai XH, Li S. Clinical observation for warm acupuncture therapy on Zu San Li(ST36)points of peripheral facial paralysis with wind cold type. Med Inf2015;28:244. doi:10.3969/j.issn.1006-1959.2015.06.356.
[23] Liu J. Clinical observation of warm needling therapy with electroacupuncture in treating refractory peripheral facial paralysis. Henan Tradit Chin Med2014;34:83-4.
[24] Xia WP. Clinical observation of warm needling therapy on peripheral facial palsy. China Health Ind 2014;11:185-6.
[25] Ni Y, Huang YL, Zheng Y. Clinical observation of warm acupuncture methods in treatment of peripheral facial paralysis. Sichuan Med J 2013;34:230-1. doi:10.3969/j.issn.1004-0501.2013.02.039.
[26] Zhou KB. Effects observation for warm needling therapy on Zu San U(ST36)points of peripheral facial paralysis in comprehensive rehabilitatetreatment. J Tradit Chin Med 2012;27:1175-6. doi:10.3969/j.issn.1003-8914.2012.06.064.
[27] Piao BY. A clinical research of treating peripheral facial paralysis with electronic-acupuncture combine warming-acupuncture Master's thesis. Nanjing University of Chinese Medicine; 2012.
[28] Du CX. Effects and nursing observation of warm needling therapy on peripheral facial palsy. Chin J Aesthet Med 2012;21:256-7. doi:10.15909/j.cnki.cn61-1347/r.2012.08.036.
[29] Han GY. A clinical research of treating wind-cold peripheral facial paralysis with warming-acupuncture Master's thesis. Nanjing University of Chinese Medicine; 2012. doi:10.7666/d.y2124610.
[30] Zhang JY. Clinical trials for acupuncture and moxibustion treatment patients Master's thesis. Nanjing University of Chinese Medicine; 2012. doi:10.7666/d.y2124571.
[31] Liang YX. Clinical Observation on Acute Peripheral Facial Paralysis by Warm Needling Therapy on Wan Gu(GB12)Points. Nanjing University of Chinese Medicine; 2011. doi:10.7666/d.y1945732.
[32] He XG. Effects observation on treating peripheral facial paralysis in Wenzhen plus medicine. Clin J Chin Med 2011;3:61-2. doi:10.3969/j.issn.1674-7860.2011.18.035.
[33] Li XY, Jiang FS. Treating peripheral facial paralysis 74 cases combined electronic-acupuncture with warm needling therapy. Hunan Jou Tradit Chin Med 2010;5:11-12. doi:10.3969/j.issn.1003-7705.2010.05.005.
[34] Bao LS, Gao X. Gao Y. Observations on the therapeutic effect of warm needling on hunt facial paralysis. Shanghai J Acupunct Moxibustion 2009;28:713-14.doi:10.13460/j.issn.1005-0957.2009,12.013.
[35] Liu XQ. Treating peripheral facial paralysis 50 cases by warm needling moxibustion. J Clin Acupunct Moxibustion 2009;25:10.
[36] Liu M. Clinical observation on peripheral facial palsy combined electronicacupuncture with warm needling therapy. Guide China Med 2009:7:73-4.doi:10.3969/j.issn.1671-8194.2009.09.040.
[37] Liu YZ, Xu LL. Therapeutic effect of warm needling therapy combined with electroacupuncture in treatment of idiopathic facial paralysis. Prog Mod Biomed 2008;8:908-9. doi:10.3969/j.issn.1673-6273.2008.05.035.
[38] Zhang LH. Treating peripheral facial paralysis 38 cases by warm needling therapy. J Clin Acupunct Moxibustion 2007;23:39. doi:10.3969/j.issn.1005-0779.2007.10.028.
[39] Zhong BM. Clinical observation on facial neuritis by acupuncture. J Clin Acupunct Moxibustion 2005;21:23-4. doi:10.3969/j.issn.1005-0779.2005.05.024.
[40] Li S. Zhong W, Peng W, et al. Effectiveness of acupuncture in postpartum depression:a systematic review and meta-analysis. Acupunct Med2018:36(5):295-301.
[41] Liu XH. Huai J, Gao J. et al. Constraint-induced movement therapy in treatment of acute and sub-acute stroke:a meta-analysis of 16 randomized controlled trials. Neural Regen Res 2017; 12(9):1443-50.
[42] Hong P, Jin R, Li M, et al. The effectiveness of acupuncture for osteoporosis:a systematic review and meta-analysis. Am J Chin Med 2018:46(3):489-513.
[2] McCaul JA, Cascarini L, Godden D, Coombes D, Brennan PA, Kerawala CJ.Evidence based management of Bell's palsy. Br J Oral Maxillofac Surg2014;52:387-91.
[3] Mooney T. Diagnosis and management of patients with Bell's palsy. Nurs Stand2013;28:44-9.
[4] Li P, Qiu T, Chao Q. Efficacy of Acupuncture for Bell's palsy:a systematic review and meta-analysis of randomized controlled trials. PLoS ONE2015;10(5):e0121880.
[5] Fabrin S, Soares N, et al. The effects of acupuncture on peripheral facial palsy sequelae after 20 years via electromyography. J Acupunct Meridian Stud2015;8:245-8. doi:10.1016/ijams.2015.01.006.
[6] Lee J, Yang J, Li CF, et al. Cortical reorganization in patients recovered from Bell's palsy:an orofacial and finger movements task-state fMRI study. Neural Plast 2016;2016:8231726. doi:10.1155/2016/8231726.
[7] Zhang CY, Xu SB, Huang B, et al. Needle sensation and personality factors influence therapeutic effect of acupuncture for treating Bell's palsy:a secondary analysis of a multicenter randomized controlled trial. Chin Med J2016;129:1789-94. doi:10.4103/0366-6999.186640.
[8] Kim Jl,Lee MS, Choi TY, et al. Acupuncture for Bell's palsy:a systematic review and meta-analysis. Chin J Integr Med 2012;18(1):48-55.
[9] Chen N, Zhou M, He L, et al. Acupuncture for Bell's palsy. Cochrane Database Syst Rev 2010;8:CD002914. doi:10.1002/14651858.CD002914,pub5.
[10] Li C, Yang J, Sun J, et al. Brain responses to acupuncture are probably dependent on the brain functional status. Evid Based Complement Alternat Med2013;2013:175278.
[11] He X, Zhu Y, Li C, et al. Acupuncture-induced changes in functional connectivity of the primary somatosensory cortex varied with pathological stages of Bell's palsy. Neuroreport 2014;25(14):1162-8.
[12] Bian Y, He X. Hu S, et al. Functional connectivity modulation by acupuncture in patients with Bell's palsy. Evid Based Complement Alternat Med 2016:2016:5928758.
[13] Park SU. Cho SY, Park JM, et al. Integrative treatment modalities for stoke victims in Korea. Complement Ther Clin Pract 2014;20:37-41.
[14] Sun ZR, Yue JH, Zhang QH. Electroacupuncture at Jing-jiaji points for neck pain caused by cervical spondylosis:a study protocol for a randomized controlled pilot trial. Trials 2013:14:360.
[15] Zhang SN, Chen G, Xiang J. To observe the clinical efficacy of warm needling moxibustion plus flash cupping for remission-stage peripheral facial paralysis(FP)due to wind-cold. J Acupunct Tuina Sci 2017;15:42-6.
[16] Sun HC. The clinical observation on acute peripheral facial palsy by warm needling therapy conbined with syndrome differentiation of chinese medicine.Lishizhen Med and Materia Medica Res 2015;26:1175-6. doi:10.3969/j.issn.1008-0805.2015.05.056.
[17] Jing YF. The clinical effects observation of 50 cases on acute peripheral facial palsy by warm acupuncture therapy. For all Health 2017;11:24-5.
[18] Li W. The clinical effects observation on acute peripheral facial palsy by warm acupuncture therapy. Nei Mongol J Tradit Chin Med 2017;36:123-4[2017-08-18]. doi:10.16040/j.cnki.cnl5-1101.2017.03.113.
[19] Zheng MH, Ye T, Wang GW. Clinical effect on peripheral facial paralysis with wind cold type by warm acupuncture therapy. J Clin Acupunct Moxibustion2016;32:58-60.
[20] Deng SB, Tang ZY. Clinical effect for warm acupuncture therapy on Zu San Li(ST36)points of peripheral facial paralysis with wind cold type. Med Hyg2016; 1:40.
[21] Guo Q. The effects on peripheral facial paralysis with wind cold type by warm needling therapy contrasted with acupuncture. World Latest Med Inf(Electron Version)2015;15:86. doi:10.3969/j.issn.1671-3141.2015.76.073.
[22] Tai XH, Li S. Clinical observation for warm acupuncture therapy on Zu San Li(ST36)points of peripheral facial paralysis with wind cold type. Med Inf2015;28:244. doi:10.3969/j.issn.1006-1959.2015.06.356.
[23] Liu J. Clinical observation of warm needling therapy with electroacupuncture in treating refractory peripheral facial paralysis. Henan Tradit Chin Med2014;34:83-4.
[24] Xia WP. Clinical observation of warm needling therapy on peripheral facial palsy. China Health Ind 2014;11:185-6.
[25] Ni Y, Huang YL, Zheng Y. Clinical observation of warm acupuncture methods in treatment of peripheral facial paralysis. Sichuan Med J 2013;34:230-1. doi:10.3969/j.issn.1004-0501.2013.02.039.
[26] Zhou KB. Effects observation for warm needling therapy on Zu San U(ST36)points of peripheral facial paralysis in comprehensive rehabilitatetreatment. J Tradit Chin Med 2012;27:1175-6. doi:10.3969/j.issn.1003-8914.2012.06.064.
[27] Piao BY. A clinical research of treating peripheral facial paralysis with electronic-acupuncture combine warming-acupuncture Master's thesis. Nanjing University of Chinese Medicine; 2012.
[28] Du CX. Effects and nursing observation of warm needling therapy on peripheral facial palsy. Chin J Aesthet Med 2012;21:256-7. doi:10.15909/j.cnki.cn61-1347/r.2012.08.036.
[29] Han GY. A clinical research of treating wind-cold peripheral facial paralysis with warming-acupuncture Master's thesis. Nanjing University of Chinese Medicine; 2012. doi:10.7666/d.y2124610.
[30] Zhang JY. Clinical trials for acupuncture and moxibustion treatment patients Master's thesis. Nanjing University of Chinese Medicine; 2012. doi:10.7666/d.y2124571.
[31] Liang YX. Clinical Observation on Acute Peripheral Facial Paralysis by Warm Needling Therapy on Wan Gu(GB12)Points. Nanjing University of Chinese Medicine; 2011. doi:10.7666/d.y1945732.
[32] He XG. Effects observation on treating peripheral facial paralysis in Wenzhen plus medicine. Clin J Chin Med 2011;3:61-2. doi:10.3969/j.issn.1674-7860.2011.18.035.
[33] Li XY, Jiang FS. Treating peripheral facial paralysis 74 cases combined electronic-acupuncture with warm needling therapy. Hunan Jou Tradit Chin Med 2010;5:11-12. doi:10.3969/j.issn.1003-7705.2010.05.005.
[34] Bao LS, Gao X. Gao Y. Observations on the therapeutic effect of warm needling on hunt facial paralysis. Shanghai J Acupunct Moxibustion 2009;28:713-14.doi:10.13460/j.issn.1005-0957.2009,12.013.
[35] Liu XQ. Treating peripheral facial paralysis 50 cases by warm needling moxibustion. J Clin Acupunct Moxibustion 2009;25:10.
[36] Liu M. Clinical observation on peripheral facial palsy combined electronicacupuncture with warm needling therapy. Guide China Med 2009:7:73-4.doi:10.3969/j.issn.1671-8194.2009.09.040.
[37] Liu YZ, Xu LL. Therapeutic effect of warm needling therapy combined with electroacupuncture in treatment of idiopathic facial paralysis. Prog Mod Biomed 2008;8:908-9. doi:10.3969/j.issn.1673-6273.2008.05.035.
[38] Zhang LH. Treating peripheral facial paralysis 38 cases by warm needling therapy. J Clin Acupunct Moxibustion 2007;23:39. doi:10.3969/j.issn.1005-0779.2007.10.028.
[39] Zhong BM. Clinical observation on facial neuritis by acupuncture. J Clin Acupunct Moxibustion 2005;21:23-4. doi:10.3969/j.issn.1005-0779.2005.05.024.
[40] Li S. Zhong W, Peng W, et al. Effectiveness of acupuncture in postpartum depression:a systematic review and meta-analysis. Acupunct Med2018:36(5):295-301.
[41] Liu XH. Huai J, Gao J. et al. Constraint-induced movement therapy in treatment of acute and sub-acute stroke:a meta-analysis of 16 randomized controlled trials. Neural Regen Res 2017; 12(9):1443-50.
[42] Hong P, Jin R, Li M, et al. The effectiveness of acupuncture for osteoporosis:a systematic review and meta-analysis. Am J Chin Med 2018:46(3):489-513.