中西医结合治疗失眠的系统评价

Systematic Review of Integrative Traditional Chinese and Western Medicine in Treatment of Insomnia

目的:分析西药联合中药治疗失眠的疗效。方法:检索维普中文科技期刊数据库(VIP)、中国知网(CNKI)、万方数据库(WanFang)、Pubmed数据库、医学文摘数据库(EMBASE)、Cochrane图书馆中单纯西药对比中药联合西药治疗失眠的随机对照试验。根据纳入和排除标准选择符合研究要求的文献。采用Cochrane协作网提供的偏倚风险评估工具评价纳入文献的方法学质量,并使用RevMan 5.1.0软件进行Meta分析。结果:共纳入随机对照试验16项,包含患者1276例。Meta分析显示,中药联合西药治疗失眠的疗效较单纯西药治疗更为显著。主要结局指标匹兹堡睡眠指数(PSQI)量表总分的加权均数差(WMD)=-2.72,95%可信区间(95%CI)为(-3.30,-2.14);总有效率的相对危险度(RR)=1.21,95%CI为(1.15,1.28)。结论:中西医结合治疗失眠疗效优于单纯西药治疗,中西医结合治疗可作为失眠的有效疗法。受纳入研究数量和质量限制,这一结论仍需高质量、大样本、多中心、随机双盲对照研究予以验证。

Objective:To analyze the curative efficacy of western medicine combined with traditional Chinese medicine on insomnia. Methods:The databases of VIP,CNKI,WanFang,PubMed,EMBASE and Cochrane Library were searched to identify the published randomized controlled trials(RCTs) of insomnia treated by integrative traditional Chinese and western medicine compared with that only treated by western medicine. Eligible literatures were included after screened according to the inclusion and exclusion criteria. The bias risk assessment tool provided by Cochrane collaborative network was used to evaluate the methodological quality of the included literatures and the Revman 5.1.0 was used to perform the Meta analysis. Results:A total of 16 RCTs with 1276 participants were included. According to the results of Meta analysis,the curative efficacy of integrative traditional Chinese medicine and western medicine was more significant than that of only western medicine. The main outcome measures were the total score of Pittsburgh sleep quality index(PSQI) and the total effective rate. For the total score of PSQI,weighted mean difference(WMD) =-2.72,95% confidence interval(95%CI) was(-3.30,-2.14). For the total effective rate,Relative Risk(RR) = 1.21,95%CI was(1.15,1.28). Conclusion:The curative efficacy of integrative traditional Chinese medicine and western medicine was better than that of only western medicine,so the integrative traditional Chinese medicine and western medicine can be used as an effective therapy for insomnia. Limited by the quantity and quality of the included studies,the above conclusion still need to be verified by some multicenter randomized double-blind control studies with high quality and large sample.