认知行为疗法对乳腺癌患者抑郁和生活质量的影响系统评价和Meta分析

Influence of Cognitive Behavioral Therapy on Depression and Quality of Life in Patients with Breast Cancer: A Systematic Review and Meta-analysis

目的系统评价认知行为疗法对改善乳腺癌患者抑郁症状、提高生活质量的效果。方法计算机检索Pub Med、CBM、维普、万方和CNKI等数据库。收集关于认知行为疗法对改善乳腺癌患者抑郁症状,提高其生活质量的随机对照试验。检索时限均为建库至2014年12月31日。由2名研究者按照纳入与排除标准筛选文献、提取资料并评价质量后,采用Rev Man 5.3进行Meta分析。结果共纳入9个研究、867例患者。纳入文献的质量等级均为B级。以抑郁为结局指标的漏斗图提示存在发表偏倚。Meta分析结果显示:认知行为疗法组与常规护理组抑郁和生活质量改善的差异有统计学意义[MD=-1.22,95%CI(-1.44,-1.00),P<0.00001],[MD=-5.83,95%CI(-8.10,-3.56),P<0.00001];[SMD=1.42,95%CI(1.09,1.75),P<0.00001],[SMD=0.57,95%CI(0.23,0.92),P=0.001];描述性结果显示:认知行为疗法能够改善乳腺癌患者的生活质量。结论认知行为疗法可以改善乳腺癌患者的抑郁,提高其生活质量。

Objective To evaluate the effect of cognitive behavioral therapy on improving depression and quality of life on patients with breast cancer. Methods We searched PubMed,CBM,Wanfang Data,VIP and CNKI to collect randomized controlled trials （RCTs） on improving depression and the quality of life in patients with breast cancer from the establishment of these databases to Dec. 30th, 2014. Two reviewers screened literature independently according to the inclusion and exclusion criteria, extracted data, and assessed methodol-ogical quality. Meta-analysis was conducted by RevMan 5.2. Results Ten RCTs involving 894 patients were idenified and the quality level of the literatures was grade B. The funnel plot taking despression as outcome indicator showed asymmetry, indicating that there was publication bias. Meta-analysis indicated that cognitive behavioral therapy significantly improved depression [MD=-1.22, 95%CI（-1.44,-1.00）, P〈0.00001], [MD=-5.83,95%CI（-8.10,-3.56）, P〈0.00001]; [SMD=1.42,95%CI（1.09, 1.75）, P〈0.00001],[SMD=0.57, 95%CI（0.23,0.92）,P=0.001] and descriptive result showed that cognitive behavioral therapy had the effect on improving the quality of life of patients with breast cancer on the overall. Conclusion Cognitive behavioral therapy can reduce depression and improve the quality of life of patients with breast cancer.