Effects of acupuncture on brain tissue metabolism and neurological function in patients with ischemic stroke: a systematic review and meta-analysis

Objective This study aims to explore the effects of acupuncture on brain tissue metabolism and neurological function in regions centers of patients with ischemic stroke (IS). Methods From the establishment of the database until May 20, 2025, a comprehensive search was conducted across several databases, including CNKI, WanFang, VIP Database, CBM, PubMed, Cochrane Library, Embase, and Web of Science. This search specifically targeted clinical randomized controlled trials (RCTs) that investigated the effects of acupuncture on cerebral tissue metabolism within the center of IS lesions and its subsequent impact on neurological function. The literature was meticulously screened, and information was extracted in accordance with the PRISMA guidelines. The quality of the literature was assessed using the risk of bias scale recommended in the Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0. Additionally, the quality of the included literature and the meta-analysis were evaluated using RevMan 5.4. Results This study included 9 randomized controlled trials involving 602 patients. The meta-analysis results indicate that acupuncture treatment significantly improves the NAA/Cr ratio [MD = 0.19, 95% CI (0.14–0.24), p < 0.00001, 8 studies, 526 subjects] and reduces the Cho/Cr ratio [MD = −0.25, 95% CI (−0.36, −0.15), p < 0.00001]. However, no significant difference was observed in reducing the Lac/Cr ratio [MD = 0.04, 95% CI (−0.24, 0.32), p = 0.79]. Additionally, acupuncture treatment led to significant improvements in the NIHSS score [MD = −2.84, 95% CI (−3.76, −1.92), p < 0.00001], the FMA score [MD = 12.94, 95% CI (7.07, 18.81), p < 0.0001], and the MoCA score [MD = 3.20, 95% CI (2.30–4.10), p < 0.00001, 2 studies, 120 subjects] compared to non-acupuncture treatment. Overall, acupuncture demonstrated superior efficacy in improving the NAA/Cr, and Cho/Cr ratios, as well as the FMA, MoCA, and NIHSS scores, among IS patients. Conclusion Adding acupuncture therapy to conventional treatment improves brain tissue metabolism and neurological function in patients with IS. It shows better efficacy compared to conventional treatment alone. However, evidence for specific outcome measures is limited. High-quality, large-scale RCTs are needed to strengthen the evidence base. Systematic review registration https://www.crd.york.ac.uk/ , CRD42024579263.