基于临床证据的循证等级针灸病谱研究：精神及行为障碍病症

Graded evidence-based diseases-spectrum of acupuncture-moxibustion treatment on mental and behavioural disorders system： based on clinical evidence

目的基于目前临床证据的强度，建立针灸治疗精神及行为障碍病症的循证等级针灸病谱。方法通过检索1978至2008年国内外7大文献数据库（CBM、CNKI、WF、VIP、Pubmed、Embase、Cochrane Library），获得针灸治疗精神及行为障碍病症临床文献，采用循证医学方法评价证据，依据证据等级强度综合分析标准，将针灸治疗病症进行循证等级划分。结果纳入研究临床文献600篇，共涉及32种精神及行为障碍病症，其中循证等级I级病谱（强证据支持针灸有效）2种，循证等级Ⅱ级病谱（强中证据支持针灸有效）8种，循证等级Ⅲ级病谱（弱中证据支持针灸有效）12种，循证等级Ⅳ级病谱（弱证据支持针灸有效）1种，循证等级V级病谱（极弱证据支持针灸有效）9种。结论目前不同强度的临床证据支持针灸可对32种精神及行为障碍病症发挥不同程度的治疗作用，但强证据尚不足，需要进一步提高临床证据质量。

Objective To classify graded evidence-based diseases-spectrum （GEDS） of acupuncture-moxibustion （AM） of mental and behavioral disorders diseases （MBDS） based on the currently strength of clinical evidence. Methods Retrieving from seven domestic and abroad databases from 1978 to 2008 （CBM, CNKI, WF, VIP, Pubmed, Embase, Cochrane Library） to acquire clinical evidence about AM follows： 7 strong evidences （the GEDS-AM level I）contain 2 types, 21 strong evidences in the middle （the treatment on mental and behavioural disorders which were estimated by evidence-based medicine methods. According to the rank of evidence above comprehensive analysis to classify GEDS-AM. Results 600 evidences were available, which involve 32 diseases of mental and behavioral disorders. The GEDS-AM of MBDS listed as GEDS-AM level II ）contain 8 types, 47 weak evidences in the middle （the GEDS-AM level III ）contain 12 types, 3 weak evidences （the GEDS -AM level IV ） contain 1 types, 22 extremely weak evidences（the GEDS -AM level V ）contain 9 types. Conclusion Currently the different rank clinical evidence supported AM had different grade therapeutic effects on the treatment of the 32 kinds of MBDS, however strong evidences were still insufficient and the high quality evidence seem to be required.