System review on treating post-stroke depression with acupuncture

针灸治疗中风后抑郁的系统评价(英文)

Objective To assess the efficacy and safety of treating post-stroke depression with acupuncture compared to western medicine systematically. Methods Databases were retrieved such as Cochrane Library, PubMed, Web of Sicence, EMbase, CBM, CNKI and WanFang Data so as to look up randomized controlled trials （RCT） of treating post-stroke depression with acupuncture and western medicine, and the time limit for the retrieval spanned from the date of database established to September 2013. By extracting data and evaluating methodological quality of included studies according to inclusion and exclusion criteria, RevMan 5.2 software was applied for Meta-analysis and evidence quality was assessed by adopting the GRADE system. Results Atotal of 23 RCTs （845 patients with post-stroke depression） were included in this study. It was revealed by Meta-analysis that the differences of the two groups were statistically significant in terms of HAMD scale scores measured at the end of the treatment by comparing the treatment of acupuncture and western medicine [SMD=0.26, 95% CI （0.11, 0.40）], but via susceptibility analysis （excluding low quality studies）, the differences were not statistically significant [SMD=-0.06, 95% CI （-0.37, 0.25）], and the reliability of the results was low; in terms of adverse events, the differences were statistically significant [RR= 0.32, 95% Cl （0.19, 0.53）], and the risk of adverse events reduced by 68% in the acupuncture group. From the assessment on evidence quality grade based on GRADE system, it was revealed that HAMD scores and adverse events were evidences with fairly low quality. Conclusion Although this system assessment showed that treating post-stroke depression with acupuncture was more effective compared with western medicine, the result was less reliable and quality of evidences was poor. The above-mentioned results need more high- quality randomized controlled trials for further verification.

目的:系统评价针灸与西药相比治疗中风后抑郁的疗效和安全性。方法:检索Cochrane Library、PubMed、Web of Sicence、EMbase、CBM、CNKI、WanFang Data等数据库,查找针灸与西药比较治疗中风后抑郁的随机对照试验(RCT),检索时限均从建库至2013年9月。按照纳入与排除标准对纳入研究进行资料提取、方法学质量评价后,采用RevMan 5.2软件进行Meta分析,并使用GRADE系统评价证据质量。结果:共纳入13个RCT文献,包括845例中风后抑郁患者。Meta分析结果显示,针灸与西药相比,在疗程结束时汉密尔顿(HAMD)量表评分方面,两组差异有统计学意义[SMD=0.26,95%CI(0.11,0.40)],但经敏感性分析(剔除低质量研究),两组差异无统计学意义[SMD=-0.06,95%CI(-0.37,0.25)],结果可靠性较低;不良事件方面,两组差异有统计学意义[RR=0.32,95%CI(0.19,0.53)],针灸组降低了68%的不良事件发生风险。基于GRADE系统的证据质量等级评价结果显示,以上HAMD评分和不良事件均为极低质量证据。结论:虽然本系统评价结果显示针灸相比西药治疗中风后抑郁具有一定疗效,但结果可靠性和证据质量较低,上述结果需更多高质量的随机对照试验来进一步验证。