针灸改善脑卒中后抑郁患者抑郁状态及日常生活能力的Meta分析

Meta-analysis of acupuncture and moxibustion in improving depressive state and activities of daily living in patients with post-stroke depression

目的系统评价针灸对脑卒中后抑郁患者抑郁状态及日常生活能力的改善作用。方法计算机检索中国知网(CNKI)、维普中文期刊服务平台(VIP)、万方数据知识服务平台(WanFang Data)、中国生物医学文献服务平台(CBM)以及PubMed、Cochrane等数据库,收集针灸治疗脑卒中后抑郁的临床随机对照试验,文献发表时间为2009年8月27日至2019年8月27日。采用Cochrane风险偏倚评估工具评价文献质量,运用RevMan 5.3软件进行Meta分析。结果共纳入14篇文献,涉及患者1120例。Meta分析结果显示:与抗抑郁剂相比,针灸疗法有较好的抗抑郁疗效[RR=1.15,95%CI(1.09,1.21),P<0.00001],能更好地改善患者的抑郁状态[SMD=-0.58,95%CI(-0.74,-0.43),P<0.00001],提高日常生活能力[SMD=0.71,95%CI(0.40,1.02),P<0.00001]。结论针灸在改善脑卒中后抑郁患者的抑郁状态、提高日常生活能力方面均优于抗抑郁剂;纳入分析的文献多数存在方法学缺陷,证据级别不高,故结论有待进一步验证。

Objective To systematically evaluate the clinical effect of acupuncture and moxibustion on improving depressive state and activities of daily living(ADL)of patients with post-stroke depression.Methods Clinical randomized controlled trials(RCTs)of acupuncture and moxibustion treatment for post-stroke depression published from August 27,2009 to August 27,2019 were collected by searching China National Knowledge Network(CNKI),VIP,Wanfang Data,Sinomed(CBM),PubMed,Cochrane and other databases.Cochrane risk bias assessment tool was used to evaluate the quality of literature,and RevMan 5.3 software was used for meta-analysis.Results A total of 14 RCTs were included involving 1,120 cases.Meta-analysis results showed that compared with antidepressants,acupuncture and moxibustion treatment had better antidepressant effects[RR=1.15,95%CI(1.09,1.21),P<0.00001],which could better improve the depressive state of patients[SMD=-0.58,95%CI(-0.74,-0.43),P<0.00001],and improve the activities of daily living[SMD=0.71,95%CI(0.40,1.02),P<0.00001].Conclusions Acupuncture and moxibustion treatment is superior to antidepressants in improving the depressive state and activities of daily living of patients with post-stroke depression.Most of the documents included in the analysis have methodological defects and the level of evidence is not high enough,so the conclusion needs further verification.