Abstract
BACKGROUND PURPOSE: The adjunctive effect of acupuncture for cerebral infarction (CI) remains inconsistent. We aimed to determine its anti-inflammatory effect, assess safety, and summarize the adjunctive use of acupuncture for CI. METHODS: We identified qualified randomized controlled trials (RCTs) from eight literature databases. Frequency analysis and Apriori association analysis were conducted using SPSS Modeler 18.0 and SPSS 26.0 software. A meta-analysis was performed using Stata 17.0 software. The credibility of the meta-results and the certainty of the evidence was assessed using trial sequential analysis (TSA) and GRADE methods, respectively. RESULTS: A total of 43 RCTs were included, comprising 3,861 participants. Acupuncture with intermittent treatment (5-7 times per week), a combination of multiple points and multiple meridians (an average of 9.35 points in each prescription), typically lasting for 2-4 weeks, was commonly used for CI treatment. Meta-analysis indicated that the adjunctive use of acupuncture reduced levels of TNF-α (SMD = -1.36; 95% CI -1.51 to -1.20, p < 0.01), hs-CRP (SMD = -0.86; 95% CI -0.99 to -0.74, p < 0.01), and IL-6 (SMD = -0.85; 95% CI -1.08 to -0.62, p < 0.01), and decreased the rate of adverse events (RR = 0.71; 95% CI 0.49 to 1.01; p < 0.05). The certainty of the evidence was rated as moderate to high. CONCLUSION: Intermittent acupuncture treatment lasting at least 2 w was commonly used for CI patients, typically involving multiple acupuncture points and meridians. Acupuncture demonstrated an anti-inflammatory effect in the treatment of CI. However, due to the low quality of the existing literature, high-quality randomized controlled trials (RCTs) are required to confirm these results in the future. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD42017078583.