针刺治疗注意力缺陷多动障碍的Meta分析

目的:评价针刺治疗注意力缺陷多动障碍(ADHD)的有效性及安全性。方法:检索CBM、CNKI、PubMed、Cochrane Library等数据库针刺治疗ADHD的临床对照试验,进行Meta分析。结果:共纳入13篇文献,1 304例患儿。Meta分析发现针刺单用或联用常规药物及行为疗法对ADHD的临床有效率、多动指数减分率均优于常规药物及行为疗法[OR=2.22,95%CI(1.65,3.00),Z=5.22,P0.00001][SMD=-0.94,95%CI(-1.41,-0.47),Z=3.89,P0.0001],针刺降低儿童多动症诊断行为量表评分优于氟哌啶醇[SMD=-7.28,95%CI(-8.32,-6.23),Z=13.62,P0.00001],针刺疗法和利他林改善肝肾阴虚型小儿多动症中医证候积分的差异无统计学意义[SMD=-1.14,95%CI(-2.53,0.25),Z=1.60,P=0.11]。针刺组的不良反应主要表现为食欲不振、口干、恶心、便秘等胃肠道症状,但对照组的不良反应高于针刺组。漏斗图基本对称,Egger’s检验P0.1,表明发表偏倚较小。结论:针刺单用或配合常规药物及行为疗法治疗ADHD优于单纯常规药物和行为疗法,但仍需更多设计严谨、方法科学的高质量随机对照试验以进一步验证。

A Meta-analysis on Acupuncture Treatment of Attention Deficit/Hyperactivity Disorder

Objective To assess the efficacy and safety of acupuncture in treating attention-deficit/hyperactivity disorder(ADHD)children.Methods A literature search was conducted to retrieve randomized cotrolled clinical trials of acupuncture in treating ADHD covering the period of the years of establishment of the databases to January 2014 from database of CBM,CNKI,PubMed,Cochrane Library by using key words"attention deficit hyperactivity disorder""hyperactivity""minimal brain dysfunction""acupuncture".Two independent researchers extracted data from located articles in a pre-defined structured way,and consulted the third researcher if necessary.Results Thirteen original trials including 1 304 cases of children with ADHD were obtained in this study according to our included criteria and excluded criteria.In these trials,acupuncture intervention alone,or acupuncture plus pharmacotherapy(methylphenidate,haloperidol)or acupuncture plus behavioral therapy were compared with simple pharmacotherapy or behavioral therapy alone.Results of Meta-analysis indicated that the total effective rate and Conners' index of hyperactivity(CIH)score-reduction rate in the acupuncture group were significantly superior to those of the other treatment groups[OR=2.22,95%CI(1.65,3.00),Z=5.22,P<0.00001][SMD=-0.94,95%CI(-1.41,-0.47),Z=3.89,P<0.0001].Acupuncture treatment is more effective than haloperidol in reducing the score of Conners' Rating Scale for ADHD [SMD=-7.28,95%CI(-8.32,-6.23),Z=13.62,P<0.00001].Acupuncture is similarly effective as Methylphenidate(Ritalin)in improving the Chinese medicine syndrome(liver-kidney yin hypoactivity)of children with ADHD [SMD=-1.14,95%CI(-2.53,0.25),Z=1.60,P=0.11].Less severe adverse effects were reported with acupuncture therapy than the pharmacotherapy(poor appetite,dry mouth,nausea and constipation).These effects were not likely due to publication bias(approximately symmetry funnel plot,Egger's test P>0.1).Conclusion Acupuncture is an effective and safe therapy in treating ADHD,combined administration of acupuncture and pharmacotherapy or behavioral therapy is more effective than the pharmacotherapy or behavioral therapy alone.However,more rigorously designed and high-quality RCTs are needed to confirm the above conclusion.