针刺治疗老年性失眠疗效的Meta分析

Meta-Analysis of Effect of Acupuncture on Senile Insomnia

目的系统评价针刺治疗老年性失眠的疗效。方法在中国知网、维普、万方、中国生物医学数据库、PubMed、Web of science、Embase和Cochrane Library数据库中检索自建库起至2024年6月24日有关针刺治疗老年性失眠的临床随机对照研究,按照纳排标准筛选文献并提取资料。根据Cochrane协作网工作手册5.1.0推荐的偏倚风险表进行文献质量评估,根据GRADE证据质量分级系统对结局指标进行等级评价,采用RevMan 5.4软件评价纳入文献质量,采用Stata18.0软件进行Meta分析。结果最终纳入18篇随机对照试验,共计1399例患者。Meta分析结果表明:与单纯西药常规治疗相比,针刺治疗可以提升老年性失眠患者临床治疗有效率[RR=1.18,95%CI(1.13,1.24),P<0.001],降低PSQI总分[MD=-1.10,95%CI(-1.25,-0.96),P<0.001]、日间功能障碍[MD=-1.38,95%CI(-1.59,-1.16),P<0.001]、入睡时间[MD=-0.66,95%CI(-0.86,-0.47),P<0.001]、睡眠时间[MD=-0.45,95%CI(-0.64,-0.25),P<0.001]、睡眠效率[MD=-0.69,95%CI(-0.89,-0.49),P<0.001]、睡眠障碍[MD=-1.24,95%CI(-1.47,-1.01),P<0.001]、睡眠质量[MD=-0.84,95%CI(-1.05,-0.64),P<0.001]。GRADE分级显示:临床疗效是高级证据,不良反应为中级证据,PSQI总分、日间功能障碍、入睡时间、睡眠效率、睡眠质量、睡眠障碍为低级证据,睡眠时间为极低质量证据。结论针刺治疗老年性失眠患者在临床有效率、PSQI各项评分方面均优于对照组,可以作为西药常规治疗的补充替代疗法在临床中进一步推广,但部分结局指标证据等级较低,仍需要更多高质量、大样本的RCT研究增加证据强度。

OBJECTIVE To systematically evaluate the therapeutic effect of acupuncture on geriatric insomnia.METHODS Randomized controlled trials(RCTs)on acupuncture in the treatment of senile insomnia were searched in CNKI,VIP,Wanfang,China Biomedical Database,PubMed,Web of science,Embase and Cochrane Library databases from inception dates to June 24,2024.Literature was screened and data were extracted based on the inclusion and exclusion criteria.The literature quality was evaluated according to the risk of bias table recommended by the Cochrane Collaboration Handbook 5.1.0,and the outcome indicators were graded using the GRADE system for the quality of evidence.RevMan5.4 software was used to evaluate the quality of the included literature,and Stata18.0 software was used to conduct Meta-analysis on the included literature.RESULTS A total of 18 studies involving 1399 patients were included.Meta-analysis showed that:compared with the simple western medicine treatment,acupuncture in the treatment of senile insomnia patients could improve the clinical effective rate[RR=1.18,95%CI(1.13,1.24),P<0.001],reduce the total PSQI score[MD=-1.10,95%CI(-1.25,-0.96),P<0.001],daytime dysfunction[MD=-1.38,95%CI(-1.59,-1.16),P<0.001],sleep latency[MD=-0.66,95%CI(-0.86,-0.47),P<0.001],sleep duration[MD=-0.45,95%CI(-0.64,-0.25),P<0.001],sleep efficiency[MD=-0.69,95%CI(-0.89,-0.49),P<0.001],sleep disorder[MD=-1.24,95%CI(-1.47,-1.01),P<0.001],sleep quality[MD=-0.84,95%CI(-1.05,-0.64),P<0.001].GRADE classification showed that the clinical efficacy was advanced evidence;the adverse reactions were intermediate evidence;the total score of PSQI,daytime dysfunction,sleep latency,sleep efficiency,sleep quality and sleep disorder were low evidence;sleep time was extremely low evidence.CONCLUSION Acupuncture intervention in senile insomnia patients is superior to the control group in clinical efficiency and various PSQI scores.Acupuncture intervention is worthy of further promotion and use in clinical practice as the complementary and alternative therapy for the conventional western medication treatment of senile insomnia.However,the evidence levels of some outcome indicators are relatively low,and more high-quality RCTs with large sample sizes are still needed to increase the strength of evidence.