针刺联合重复经颅磁刺激治疗脑卒中后抑郁疗效的Meta分析

A Meta-analysis of Efficacy of Acupuncture Combined with Repetitive Transcranial Magnetic Stimulation for Post-Stroke Depression

目的:系统评价针刺联合重复经颅磁刺激治疗脑卒中后抑郁的临床疗效。方法:检索CNKI、Sinomed、Wanfang、VIP、PubMed、Cochrane Library、Web of science、EMBASE数据库中关于针刺联合重复经颅磁刺激治疗脑卒中后抑郁的临床随机对照试验,检索时间自建库起至2023年7月。通过Cochrane偏倚风险评估工具对纳入文献进行偏倚分析和质量评价,Revman5.4软件进行Meta分析以及采用GRADE软件对结局指标进行证据质量评价。结果:纳入10篇文献,共622例受试者。针刺联合重复经颅磁刺激在改善卒中后抑郁患者的临床疗效[RR=1.14,95%CI(1.06,1.24),P=0.0009],汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分[MD=-3.75, 95%CI(-5.86,-1.64), P=0.0005],匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)等评分方面均优于对照组。结局指标质量评价结果显示临床疗效为中级,HAMD评分为低级,PSQI评分为极低级。结论:针刺联合重复经颅磁刺激在改善脑卒中后患者的抑郁情况方面具有显著优势。

Objective:To systematically evaluate the clinical efficacy of acupuncture combined with repetitive transcranial magnetic stimulation(rTMS)in treatment of post-stroke depression.Methods:A systematic search was conducted in databases of CNKI,CBM,Wanfang,VIP,PubMed,Web of Science,Cochrane Library and EMBASE for randomized controlled trials(RCTs)of acupuncture combined with rTMS in the treatment of post-stroke depression from their inception to July 2023.The Cochrane risk of bias assessment tool was used to assess the risk of bias and the quality of the included literature.RevMan 5.4 software was used for meta-analysis,and GRADE software was used to evaluate the quality of evidence for the outcome indicators.Results:Ten studies involving 622 participants were included.The meta-analysis results showed that acupuncture combined with rTMS significantly improved clinical efficacy in patients with post-stroke depression[RR=1.14,95%CI(1.06,1.24),P=0.0009].Moreover,the Hamilton Depression Scale(HAMD)score[MD=-3.75,95%CI(-5.86,-1.64),P=0.0005]and Pittsburgh Sleep Quality Index(PSQI)score showed significant improvement compared to the control group.The quality of evidence was rated as moderate for clinical efficacy,low for HAMD score,and very low for PSQI score.Conclusion:Acupuncture combined with rTMS demonstrates significant benefits in improving depression in patients after stroke.