针灸联合心理治疗改善脑卒中后抑郁的Meta分析

Acupuncture combined with psychotherapy in improving post-stroke depression:a Meta-analysis

目的:采用Meta分析方法评价针灸联合心理治疗对脑卒中后抑郁的干预效果。方法:计算机检索PubMed、EMbase、Web of Science、中国期刊全文数据库(CNKI)、万方数据库(WanFang Data)、维普(VIP)数据库,搜集针灸联合心理治疗对脑卒中后抑郁干预的随机对照试验(RCT),检索时限从建库至2020年4月1日。由2名研究者独立筛选文献、提取资料并评价研究的偏倚风险,采用RevMan 5.4软件进行Meta分析。结果:共纳入15项研究,涉及1169例病人。Meta分析结果显示:试验组干预结束后的即时效果优于对照组[WMD=-4.01,95%CI(-5.28,-2.75),P<0.00001],亚组分析显示干预3周[WMD=-1.14,95%CI(-2.15,-0.13),P=0.03]、4周[WMD=-4.77,95%CI(-6.49,-3.05),P<0.00001]、6周[WMD=-2.25,95%CI(-3.62,-0.88),P=0.001]、8周[WMD=-4.62,95%CI(-7.27,-1.98),P=0.0006]即时效果优于对照组;干预长期效果显示试验组较对照组更能有效降低病人的抑郁程度[WMD=-2.61,95%CI(-3.64,-1.57),P=0.03]。结论:现有证据表明,对脑卒中后抑郁病人开展针灸和心理联合治疗,干预3周以上能明显改善病人的抑郁状态,长期效果明显。

Objective:Meta-analysis was used to evaluate the intervention effect of acupuncture combined with psychotherapy on post-stroke depression.Methods:Randomized controlled trials on acupuncture combined with psychotherapy on post-stroke depression were searched from PubMed,EMbase,Web of Science,CNKI,WanFang Data and VIP.The retrieval time was from inception to April 1,2020.Two researchers independently screened the literature,extracted data and evaluated the risk of bias.RevMan 5.4 software was used for Meta-analysis.Results:A total of 15 studies were included,involving 1169 patients.Meta-analysis results showed that the immediate effect of the experimental group was better than that of the control group[WMD=-4.01,95%CI(-5.28,-2.75),P<0.00001],Subgroup analysis showed that the immediate effect of intervention for 3 weeks[WMD=-1.14,95%CI(-2.15,-0.13),P=0.03],4 weeks[WMD=-4.77,95%CI(-6.49,-3.05),P<0.00001],6 weeks[WMD=-2.25,95%CI(-3.62,-0.88),P=0.001]and 8 weeks[WMD=-4.62,95%CI(-7.27,-1.98),P=0.0006]was better than that of the control group.The long-term effect of intervention showed that the experimental group could effectively reduce the depression score of patients than the control group[WMD=-2.61,95%CI(-3.64,-1.57),P=0.03].Conclusion:Current evidences shows that acupuncture combined with psychotherapy for patients with post-stroke depression for more than 3 weeks can significantly improve the depressive state of patients,its the long-term effect is obvious.