针刺治疗围绝经期情绪障碍安全性和疗效的系统评价

Safety and Effectivenss of Acupuncture for Women Emotional Disorders in Perimenopause:A Systermatic Review

目的:评价针刺对围绝经期情绪障碍的安全性和疗效。方法:检索中英文数据库至2016年10月发表的关于针刺治疗围经期情绪障碍的随机对照试验(RCT)文章,按照纳入与排除标准进行文献筛选,提取最终纳入文献数据,进行系统评价。结果:共纳入RCT文献12篇,1045例患者。Meta分析得出:针刺对于围绝经期情绪障碍有效率优于药物(Z=3.24P=0.001),且同质性好(P=0.53,I^2=0%);针刺对于围绝经情绪障碍的HAMD评分短程(疗程≤30d)优于药物(Z=2.81P=0.005),长程(疗程>30d)相当(Z=0.56,P=0.57),且存在组间异质性(P=0.11I^2=59.9%);针刺相对于药物能够明显改善围绝经期情绪障碍Kupperman评分(Z=6.04,P<0.00001),且存在组间异质性(P=0.06,I^2=72%);针刺相对于药物能够明显改善围绝经期情绪障碍E2含量(Z=4.26,P<0.0001),且存在组间异质性(P=0.003,I^2=88.4%);针刺对于围绝经期情绪障碍安全性优于药物(Z=7.20,P<0.00001),且同质性好(P=0.33,I^2=13%)。结论:针刺治疗围绝经期情绪障碍安全有效,但由于纳入研究在方法学和质量方面还存在一些不足之处,需要开展更多设计严谨、大样本、多中心的随机对照试验进一步支持上述结论。

Objective:To systematically evaluate the safety and effectivenss of acupuncture for women emotional disorders in perimenopause.Mothods:Through the electronic retrieval from engliash and Chinese databases,randomized controlled trial(RCT) literature regarding acupuncture treatment of women emotional disorders in perimenopause to October 2016 was collected,and they were screened according to inclusion and exclusion criteria.The included RCTs were extracted and evaluated.Methods:Results:A total of 12 RCTs were included in the analysis,involving 1045 patients.Meta-analysis results showed that acupuncture had better effective rate than medicine on women emotional disorders in perimenopause(Z=3.24 P=0.001),and best homogeneity(P=0.53,I2=0%).Acupuncture had better efficacy than medicine on short-term HAMD score(Z=2.81,P=0.005),but long-term HAMD score was equal(Z=0.56,P=0.57),and heterogeneity existed between groups(P=0.11,I2=59.9%).Compared with medicine,acupuncture could significantly improve the Kupperman score of women emotional disorders in perimenopause(Z=6.04,P<0.00001),and heterogeneity existed between groups(P=0.06,I2=72%).Compared with medicine,acupuncture could significantly improve the E2 levels of women emotional disorders in perimenopause(Z=4.26,P<0.0001),and heterogeneity existed between groups(P=0.003,I2=88.4%).Acupuncture had better safety than medicine on women emotional disorders in perimenopause(Z=7.20,P<0.00001) and homogeneity better(P=0.33,I2=13%).Conclusion:Acupuncture is safe and effective for women emotional disorders in perimenopause,but due to the low methodological quality of included studies,this conclusion will need to more rigorous design,large sample and multicenter RCTs to support.