针刺治疗原发性抑郁症系统评价的方法学质量及适用性评价

Quality and applicability assessment for systematic reviews on acupuncture treatment for primary depression

目的评价针刺治疗原发性抑郁症系统评价的方法学质量和研究结果的适用性。方法计算机检索Web of Science、EMbase、PubMed、The Cochrane Library、CNKI、CBM、WanFang Data和VIP数据库获取公开发表的针刺治疗原发性抑郁症的系统评价/Meta分析,检索时限均从建库至2018年12月5日。由2名研究者独立筛选文献并提取资料,运用AMSTAR 2工具和ROBIS工具评价纳入研究质量,同时采用CASP-S.R中涉及结果适用性条目评价系统评价的适用性。结果最终纳入18篇系统评价/Meta分析,均以针刺干预为主,包含2个主要结局指标。根据AMSTAR 2评价结果,有4个高质量研究、12个中等质量研究和2个低质量研究。根据ROBIS工具,共有10个研究偏倚风险高,7个研究偏倚风险较低,1个研究偏倚风险不确定。根据CASP-S.R,仅有4篇研究设计结果可能适用于当地人群,没有研究设计获益与成本危害之间的关系。结论针刺治疗原发性抑郁症的系统评价方法学质量属中等水平,部分研究存在一定的偏倚,大部分研究可能不能直接适用于当地人群,所有研究均没有获益与成本危害之间的关系。期望今后的系统评价严格按照系统评价制作方法进行,以提高研究质量、减少偏倚,同时应当考虑到系统评价对不同人群的适用性以及获益与成本危害之间的关系。另外,尚需在针刺治疗原发性抑郁症的原始研究上投入更多的考虑,以提供更高质量、科学、精确的临床证据。

Objectives To comprehensively evaluate the methodological quality and applicability of the results of systematic reviews on acupuncture treatment for primary depression. Methods Web of Science, EMbase, PubMed, The Cochrane Library, CNKI, CBM, WanFang Data and VIP databases were electronically searched to collect systematic reviews/meta-analyses on acupuncture treatment for primary depression from inception to December 5 th, 2018. Two researchers independently screened and extracted data by using tools of AMSTAR 2 to evaluate the methodological quality, using ROBIS to assess risk of bias, and using CASP-S.R to evaluate the applicability of the results. Results A total of 18 systematic reviews/meta-analyses were included, and all focused on acupuncture intervention, including 2 primary outcome indicators. According to AMSTAR 2 evaluation results, there were 4 high quality studies, 12 medium quality studies and 2 low quality studies;ROBIS results found 10 high bias risk studies, 7 low bias risk studies and 1 unclear;CASP-S.R showed only 4 design studies applicable to local individuals, and there were no studies on the relationship between design benefits, hazards and costs. Conclusions The quality of systematic reviews/meta-analyses for acupuncture treatment of primary depression is moderate, however with a certain bias. Most studies may not directly benefit local individuals. All studies have no relationship with cost hazards. It is expected for further reviewers to strictly follow systematic evaluation method to improve research quality and reduce bias, while the applicability of the systematic review to individuals from different regions should be considered as well as the relationship between the benefit and cost hazard. In addition, more valid RCTs are required to provide higher quality evidence and explore correlated and comprehensive mechanism.