认知行为疗法对体外受精-胚胎移植患者焦虑抑郁及妊娠结局影响的Meta分析

Meta analysis of the effect of cognitive behavioral therapy on anxiety depression and pregnancy outcome in IVF-ET patients

目的系统评价认知行为疗法(Cognitive behavioral therapy,CBT)对体外受精-胚胎移植(In vitro fertilization and embryo transfer,IVF-ET)患者焦虑抑郁及妊娠结局的影响。方法计算机检索PubMed数据库、EMbase、Cochrane Library、Web of Science、中国期刊全文数据库(CNKI)、中国生物医学文献(CBM)和万方等数据库中关于CBT对IVF-ET患者焦虑抑郁及妊娠结局影响的随机对照试验(Randomized controlled trial,RCT)。由2名研究者根据纳入和排除标准独立检索、筛选文献、提取资料与评价文献质量后,采用RevMan 5.0软件进行Meta分析。结果最终纳入9篇RCT研究,总样本1063例。Meta分析结果显示:与常规护理相比,CBT能显著改善IVF-ET患者的焦虑情绪,降低SAS焦虑量表评分:MD=-8.26,95%CI(-10.10,-6.41),P<0.00001及SAI焦虑量表评分:MD=-3.31,95%CI(-5.89,-0.72),P=0.01;同时改善了IVF-ET患者的抑郁水平:MD=-7.28,95%CI(-9.01,-5.55),P<0.00001;有效提高了IVF-ET患者临床妊娠率:OR=1.64,95%CI(1.19,2.25),P=0.002。结论CBT可有效改善IVF-ET患者焦虑抑郁情绪,还可提高患者的临床妊娠率。

Objective To systematically evaluate the effects of cognitive behavioral therapy(CBT) on anxiety, depression and pregnancy outcome in patients undergoing in vitro fertilization and embryo transfer(IVF-ET). Methods A computerized search in PubMed, EMBASE, Cochrane Library, Web of Science, China Knowledge Network Full Text Database(CNKI), China Biomedical Literature Database(CBM) and Wan Fang Data was performed for relevant randomized controlled trials(RCTs) which investigated the effects of cognitive behavioral therapy on anxiety, depression and pregnancy outcomes in patients with IVF-ET, and references to subject-related research and reviews were traced back. Meta-analysis was performed using RevMan5.0 software after two researchers independently completed literature search, screening, data extraction and quality evaluation. Results The study eventually included 9 RCT studies, including 1063 subjects. Meta-analysis results showed that cognitive behavioral therapy significantly improved anxiety in patients with IVF-ET and decreased SAS anxiety scale score [MD=-8.26, 95%CI(-10.10,-6.41), P<0.001] and SAI anxiety scale score [MD=-3.31, 95%CI(-5.89,-0.72), =0.01] in patients with IVF-ET compared with conventional care;and improved depression in patients with IVF-ET [MD=-7.28, 95%CI(-9.01,-5.55),P<0.001];In addition, it also effectively improved the clinical pregnancy rate of patients with IVF-ET [OR=1.64, 95% CI(1.19, 2.25),P=0.002]. Conclusion As a new type of psychological intervention, cognitive behavioral therapy can not only improve the anxiety and depression of patients with IVF-ET, but also effectively improve the clinical pregnancy rate of patients.