八段锦应用于抑郁症的系统评价

The effect of Baduanjin on depression:a systematic review

目的系统评价八段锦干预抑郁症的临床有效性。方法检索PubMed、Web of Science、Cochrane library、PsycINFO、SinoMed、中国知网、维普、万方等数据库,搜集八段锦治疗抑郁症随机对照试验(randomized controlled trial,RCT),检索时限从建库至2020年7月22日。根据Cochrane的risk of bias标准评估偏倚风险,采用RevMan 5.4软件行Meta分析,并按照GRADE系统对结局指标进行证据分级。结果纳入30项RCT,单独干预10项,联合干预20项,包括2935例患者。Meta分析结果显示,单独八段锦干预抑郁症,对降低SDS评分(MD=-4.16,95%CI:-6.42~-1.90,P=0.0003)、SCL-90抑郁因子评分(MD=-0.18,95%CI:-0.27~-0.09,P=0.0001)、MARDS评分(MD=-5.54,95%CI:-10.57~-0.51,P=0.03)、BDI评分(MD=-3.27,95%CI:-5.77~-0.76,P=0.01)、PHQ-9评分(MD=-1.01,95%CI:-1.84~-0.18,P=0.02),优于对照措施,差异有统计学意义;对GDS-15评分差异无统计学意义。相比对照措施,八段锦联合对照措施干预抑郁症,对降低HAMD评分(MD=-5.93,95%CI:-7.82~-4.05,P<0.01)、SDS评分(MD=-6.89,95%CI:-8.57~-5.22,P<0.01)、SCL-90抑郁因子评分(MD=-0.32,95%CI:-0.46~-0.18,P<0.01)、GDS-15评分(MD=-1.34,95%CI:-2.02~-0.66,P=0.01),效果更优,差异有统计学意义;对BDI评分有降低趋势,但差异无统计学意义。GRADE结局指标评价显示证据质量为中等到极低级别。结论上述证据提示八段锦单独干预或联合对照措施干预抑郁症具有一定疗效,但受纳入研究质量与数量的限制,研究结论需更多高质量研究予以验证。因此,建议未来研究在八段锦干预抑郁症的研究设计、实施方案上进一步探索和完善,开展更多大样本、重要结局的高质量随机对照临床试验,以期获得更高质量的临床证据。

Objective To perform a systematical review on the clinical effect of Baduanjin(BDJ)on depression.Methods We conducted a comprehensive search for literatures of randomized controlled trials(RCTs)on the effect of Baduanjin on depression through online databases of PubMed,Web of Science,Cochrane library,PsycINFO,SinoMed,CNKI,VIP and Wanfang published until July 222020.The Cochrane risk of bias tool was used to assess the risk of bias of RCTs.RevMan 5.4 software was used for Meta-analysis.The quality of evidence of major outcome was graded according to GRADE criteria.Results A total of 30 RCTs(10 of BDJ intervention alone and 20 of combined intervention)with 2935 cases were included.Meta-analysis showed that compared to control group,BDJ exercise alone could significantly reduce SDS score(MD=-4.16,95%CI:-6.42--1.90,P=0.0003),SCL-90 score(MD=-0.18,95%CI:-0.27--0.09,P=0.0001),MARDS score(MD=-5.54,95%CI:-10.57--0.51,P=0.03),BDI score(MD=-3.27,95%CI:-5.77--0.76,P=0.01)and PHQ-9 score(MD=-1.01,95%CI:-1.84--0.18,P=0.02),the differences were statistically significant,while there was no difference in GDS-15 score.Meanwhile,compared with control intervention,BDJ combined with control intervention could significantly reduce HAMD score(MD=-5.93,95%CI:-7.82--4.05,P<0.01),SDS score(MD=-6.89,95%CI:-8.57--5.22,P<0.01),SCL-90 score(MD=-0.32,95%CI:-0.46--0.18,P<0.01)and GDS-15 score(MD=-1.34,95%CI:-2.02--0.66,P=0.01),the differences were statistically significant.The qualities of evidence for main outcomes were rated as"medium"to"very low".Conclusions BDJ intervention alone or combined with other control intervention may potentially confer beneficial effect on expression.Due to limited quality and quantity of the included studies,more high quality siudies are needed to verify the above conclusions.It is suggested that in the future studies we should improve the study design and implementation plan,conduct large-scale RCTs with critical outcomes in order to obtain higher quality clinical evidences.