电针与抗抑郁西药治疗脑卒中后抑郁症疗效的系统评价

Efficacy of Electroacupuncture and Antidepressants for Post-Stroke Depression: A Systematic Review of Randomized Controlled Trials

目的:系统评价电针与抗抑郁西药比较对脑卒中后抑郁症(PSD)的有效性和安全性。方法:计算机检索Pub Med、The Cochrane library、CNKI、VIP、CBM及Wan Fang数据库中关于电针与抗抑郁西药比较治疗PSD的随机对照试验,检索时限为建库至2015年12月;采用Cochrane系统评价员手册5.1.0推荐的方法,由2名研究者独立地完成文献筛选、资料提取及纳入研究的质量评价,并采用Rev Man 5.3软件进行Meta分析。结果:最终共纳入14个RCT研究,共计1180例。Meta分析显示:在降低PSD患者HAMD评分方面,电针组优于对照组,差异有统计学意义[MD=-0.77,95%CI(-1.47,-0.07),P=0.03];电针治疗PSD的临床疗效优于对照组,差异有统计学意义[RR=1.11,95%CI(1.05,1.19),P=0.000 7];电针组与对照组均有不良反应,其中对不良反应作描述性分析的研究表明电针组较对照组不良反应发生率更低。结论:目前证据支持电针治疗PSD的有效性与安全性均优于抗抑郁西药,但鉴于本次纳入研究质量偏低,本次系统评价不能代替高质量的RCT研究结果,仍需更多高质量的RCT以进一步验证。

Objective： To assess the efficacy and safety of electroacupuncture （EA） and antidepressants for post-stroke depression （PSD）. Methods： Searching PubMed, The Cochrane library, China National Knowledge Infrastructure database （CNKI） ,VIP medicine information system （VIP） and Chinese Biomedical Database （CBM） about EA and antidepressants for the treatment of PSD in clinical randomized control trials（RCTs） from the inceptions of the databases to December 2015. According to the Cochrane Reviewers^Handbook 5.1.0, two authors independently extracted the data and assessed the methodological quality of each eligible studies. Meta - analysis was conducted with RevMan 5.3 soft- ware. Results： Fourteen eligible studies （1180 participants） were eventually included in this review. Meta- analysis showed ： EA group was more effective in decreasing Hamilton Depression Rating Scale （HAMD） score than that of control group （MD =-0.77,95% CI - 1.47 to -0.07, P = 0.03）. And the clinical effective rate of EA group was higher compared with that of control group （ RR = 1.11,95 % CI 1.05 to 1.19,P = 0.0007）. Base on the descriptive analysis, in the control group there were more side effects than that in the EA group. Conclusions： Currently, the evidence suggests that EA may be a more effective and safer treatment for PSD than antidepressar^ts, However,the further research with rigorous well - designed RCTs should be conducted because of generally low methodology of the included studies,