基于Meta分析与多指标决策的针刺治疗原发性抑郁症的干预方式研究

Research on the optimal intervention mode of acupuncture treatment on major depressive disorder based on Meta analysis and multiple objectives decision making

目的:基于针刺治疗原发性抑郁症(MDD)的高质量临床证据与多指标决策,获得针刺治疗MDD最优的干预方式。方法:计算机检索国内外医学文献数据库,全面收集2012年以前针刺治疗MDD的高质量临床证据。按照Jadad评分法评价证据质量,采用RevMan 5.1软件进行Meta分析及效应量统计评价。对获得的临床证据建立数据标准化矩阵,运用TOPSIS筛选最优针刺干预方式。结果:共纳入14项研究,Meta分析结果显示针刺与选择性5-羟色胺再摄取抑制剂(SSRIs)相比较在临床控制率、显效率、有效率及临床总有效率均无统计学差异,针刺配合SSRIs基础上可提高临床控制率及临床总有效率;最优干预方式以电针配合SSRIs干预6周达到最好整体疗效。结论:基于现阶段的临床证据,针刺治疗轻中度MDD应以电针配合SSRIs干预6周为最优干预方式,可显著提高临床控制率和临床总有效率。

Objective： To explore the optimal intervention mode of acupuncture treatment on major depressive disorder （MDD） based on Meta analysis and multiple objectives decision making （MODM） with high quality clinical evidences. Methods： The published medical papers on clinical trails for acupuncture treatment of MDD were widely retrieved from Chinese and abroad database. Quality of clinical evidence was evaluated by Jadad scale and the Cochrane Collaboration＇s. RevMan 5.1 software was used for data analyses. The appraisal result of clinical evidence was analyzed by MODM to achieve optimal intervention mode of acupuncture treatment by constructed the model and matrix. Results： 14 studies according with the inclusive criterion were retrieved. Meta-analyses showed efficacy outcomes such as clinical control rate, effective rate, efficient rate and aggregate effective rate in the acupuncture was similar compared with SSRIs, and there was no significant difference. There was a difference between acupuncture coordinate with SSRIs and SSRIs at aggregate effective rate and clinical control rate. MODM showed that the optimal intervention mode was the acupuncture coordinate with SSRIs at least 6 weeks. Conclusion： According to the present stage clinical evidences, acupuncture treatment on mild and moderate MDD should coordinate with SSRIs. Electro-acupuncture with SSRIs could raise clinical control rate and aggregate effective rate at least 6 weeks.