文章摘要
徐换,徐小静,宋莎莎,童佩,陆敏.A型肉毒毒素治疗儿童痉挛型脑瘫疗效的Meta分析[J].中国康复,2019,34(9):489-493
A型肉毒毒素治疗儿童痉挛型脑瘫疗效的Meta分析
Efficacy of botulinum toxin A injection for spastic cerebral palsy: A meta-analysis
  
DOI:
中文关键词: BTX-A  脑性瘫痪  痉挛  Meta 分析
英文关键词: botulinum toxin A  cerebral palsy  spasm  Meta-analysis
基金项目:
作者单位
徐换 泰康同济(武汉)医院康复医学科武汉 430050 
徐小静 泰康同济(武汉)医院康复医学科武汉 430050 
宋莎莎 泰康同济(武汉)医院康复医学科武汉 430050 
童佩 泰康同济(武汉)医院康复医学科武汉 430050 
陆敏 华中科技大学同济医学院附属同济医院康复医学科武汉 430030 
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中文摘要:
  目的:系统评价A型肉毒毒素(BTX-A)治疗儿童痉挛型脑瘫的临床疗效及安全性。方法:计算机检索PubMed、EMbase、Cochrane Library、中国生物医学文献数据库(CMB)、中国知网(CNKI)和万方数据库(WanFang Data)。搜集关于BTX A治疗儿童痉挛型脑瘫患者的随机对照试验(RCT),检索时限均为从建库至2018年11月1日。由至少2位评价员按纳入与排除标准进行文献筛查、资料提取和质量评价。利用Review Manager 5.3及State 12软件进行Meta分析。结果:共有22篇研究符合纳入标准,共1218例患者,肉毒素治疗组620例,对照组598例。Meta 分析结果显示:肉毒素治疗组在MAS评分[MD =-0.82,95%CI(-0.86,-0.79),Z=50.34,P<0.05],GMFM评分[MD =9.22,95%CI(7.80,10.65),Z=12.70,P<0.05],ADL评分[MD =11.38,95%CI(7.51,15.24),Z=5.77,P<0.05],CSS评分[MD =-1.9,95%CI(-3.45,-0.35),Z=2.4,P<0.05],关节屈曲度[MD =0.7,95%CI(0.39,1.02),Z=4.4,P<0.05]及有效率[RR =1.3,95%CI(1.13,1.5),Z=3.63,P<0.05]方面优于对照组,差异有统计学意义(P<0.05)。结论:BTX A结合康复训练能够明显改善痉挛型脑瘫患儿的肢体运动功能、肌肉紧张状态及生活质量,是一种有效的治疗儿童痉挛型脑瘫的方法;但在临床应用过程中应严格把握治疗剂量,根据患儿病情综合考虑。
英文摘要:
  Objective: To assess the efficacy and safety of botulinum toxin A (BTX-A) injection in the treatment of spastic cerebral palsy. Methods: A systematic search of all the studies published was conducted on the PubMed, EMbase, Cochrane Library, Chinese Biomedical Literature Database (CBM), China National Knowledge Internet (CNKI) and Wanfang Data medical information system (WF). Randomized controlled trials (RCT) of BTX-A treatment of spastic cerebral palsy were identified from database foundation to November 1, 2018. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of included studies. Meta-analyses were performed by using the Rev-Man 5.3 and State 12 software. Results: Twenty-two studies involving 1218 patients were included. Among the patients, 620 cases were in the botulinum toxin group and 598 cases were in the control group. The results of the meta-analysis indicated that, compared with control group, BTX-A treatment group had advantages of modified Ashworth score (MD =-0.82, 95% CI -0.86 to -0.79, P<0.05), GMFM score (MD=9.22, 95% CI 7.80 to 10.65, P<0.05), ADL score (MD=11.38, 95% CI 7.51 to 15.24, P<0.05), CSS score (MD=-1.9, 95% CI -3.45 to -0.35, P<0.05), joint flexible degree (MD=0.7, 95% CI 0.39 to 1.02, P<0.05) and effective rate (RR=1.3, 95% CI 1.13 to 1.5, P<0.05). Conclusion: BTX-A was demonstrated to be effective for spastic cerebral palsy. BTX-A combined with rehabilitation therapy can significantly improve patient's motor function of limbs, muscle tension and quality of life. However, The therapeutic dose should be strictly controlled and the treatment approach should be chosen individually in?clinical work.
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