针刺治疗卒中后抑郁的疗效及安全性系统评价

Systematic Evaluation of Efficacy and Safety of Acupuncture in Treatment of Poststroke Depression

目的:系统评价针刺治疗卒中后抑郁的临床疗效及安全性。方法:检索中国知网、万方数据库等中文数据库以及PubMed、Cochrane图书馆临床对照试验注册库等英文数据库,全面收集自建库以来至2018年5月针刺治疗中风后抑郁的随机对照试验,按照纳入和排除标准筛选高质量文献,提取有效数据。运用RevMan5.3软件对纳入的文献进行异质性检验,并进一步对治疗后针刺组与药物组的临床总有效率、汉密尔顿抑郁量表(HAMD)评分等结局指标进行Meta分析。结果:最终纳入8篇文献,包含769例患者。Meta分析结果显示,与单纯氟西汀治疗比较,针刺及针刺联合其他疗法治疗PSD能提高临床总有效率(RR=1.08,95%CI[1.01,1.16]),降低HAMD评分(MD=-1.15,95%CI[-1.97,-0.32])、白细胞介素-6(IL-6)水平(MD=-1.78,95%CI[-2.93,-0.64])、肿瘤坏死因子-α(TNF-α)水平(MD=-9.53,95%CI[-18.10,-0.96])及不良反应发生率(RR=0.16,95%CI[0.07,0.35])。结论:与氟西汀比较,针刺治疗卒中后抑郁具有较高的临床疗效,且在改善患者症状、减轻不良反应等方面具有显著优势。但因纳入文献数量较少、方法学质量不高,上述结论尚需更多高质量研究予以验证。

Objective:To systematically evaluate the clinical efficacy and safety of acupuncture in the treatment of poststroke depression(PSD).Methods:Randomized controlled trials of acupuncture in the treatment of PSD were retrieved from Chinese databases such as Chinese National Knowledge Infrastructure(CNKI),Wanfang database,etc.and English databases such as PubMed,Cochrane Central Register of Controlled Trials,etc.The time limit was from the building date of the datebase to May,2018.Literatures of high quality were screened according to inclusion criteria and exclusion criteria,and valid data were extracted.RevMan 5.3 software was used to test the heterogeneity of the included literatures,and further meta-analysis was conducted on the clinical total effective rate,Hamilton Depression Scale(HAMD)score,and other outcome indicators of the acupuncture group and the drug group after treatment.Results:A total of 8 studies with 769 patients were finally included.The results of Meta-analysis showed that compared with treatments by using fluoxetine alone,acupuncture and acupuncture combined with other therapy in the treatment of PSD could increase the clinial total effective rate(RR=1.08,95%CI[1.01,1.16]),decrease the HAMD score(MD=-1.15,95%CI[-1.97,-0.32]),IL-6 level(MD=-1.78,95%CI[-2.93,-0.64]),TNF-αlevel(MD=-9.53,95%CI[-18.10,-0.96]),and the incidence of adverse reactions(RR=0.16,95%CI[0.07,0.35]).Conclusions:Compared with fluoxetine,acupuncture has a higher clinical efficacy in the treatment of PSD,and has significant advantages in improving the symptoms of patients and reducing adverse reactions.However,due to the small number and low methodological quality of the included literatures,the above conclusions need to be verified by more high-quality studies.