针药结合治疗抑郁症效应特征的Meta分析

目的:评价电针或针刺结合SSRIs类抗抑郁药物治疗抑郁症的临床疗效。方法:计算机检索中国生物医学文献数据库、中国知网、维普数据库和万方数字化期刊群,Pub Med、EMBASE和Cochrane Library;搜集随机对照试验(RCT);主要结果是有效率和汉密尔顿抑郁评定量表(HAMD)。结果:共纳入26项临床试验,1842例患者。Meta分析结果显示,针药结合组有效率显著高于药物组[22项试验,n=1462,I^2=0%;相对危险度(RR1.17,95%CI 1.12~1.23;P<0.00001)]。针药结合组HAMD评分在1、2、4、6、8周(1周,n=877,I^2=65%,WMD=2.07,95%CI 1.06~3.08;2周,n=778,I^2=75%,WMD=3.46,95%CI 2.15~4.77;4周,n=1598,I^2=68%,WMD=2.93,95%CI 2.23~3.62;6周,n=747,I^2=52%,WMD=3.25,95%CI 2.25~4.24;8周,n=177,I^2=94%,WMD=5.89,95%CI 1.28~10.50)均优于对照组,不良反应发生率显著低于药物组[12项试验,n=860,I^2=0%;相对危险度(RR0.37,95%CI 0.26~0.53;P<0.00001)]。针药结合组Asberg氏抗抑郁药副反应量表(SERS)评分在2、4、6周(n=691,I^2=0%,WMD=2.42,95%CI 2.00~2.84)均低于对照组。结论:与药物组比较,电针或针刺结合盐酸帕罗西汀或氟西汀疗效确切,并且优于药物组治疗。这一优势从治疗第1周时开始,可持续至第8周,且不良反应更少。

Effectiveness of Combined Electro-Acupuncture and SSRIs for Depression:A Systematic Review and Meta-analysis

Objective To assess the clinical effectiveness of combined electro-acupuncture or acupuncture and SSRIs for depression.Methods The following databases were searched:Pub Med,EMbase,The Cochrane Library,CBM,CNKI,VIP and Wan Fang Data databases.Only randomized controlled trials(RCTs)were considered.Primary outcomes were effective rate and the Hamilton Rating Scale for Depression(HAMD).Results 23 trials involving 1682 patients were included.The result of this meta-analysis demonstrated that the acupuncture group had a significantly greater effective rate compared with the control group(22 trials,n=1462,I^2=0%;relative risk(RR)1.17,95%CI 1.12 to 1.23;P<0.00001).Moreover,the acupuncture group was superior to the control group in HAMD scores before and after treatment in 1 week and 2、4、6、8 weeks.(1 week,n=877,I^2=65%,WMD=2.07,95%CI 1.06 to 3.08;2 week,n=778,I^2=75%,WMD=3.46,95%CI 2.15 to 4.77;4 weeks,n=1598,I^2=68%,WMD=2.93,95%CI 2.23 to 3.62;6 weeks,n=747,I^2=52%,WMD=3.25,95%CI 2.25 to 4.24;8 weeks,n=177,I^2=94%,WMD=5.89,95%CI 1.28 to 10.50).the result of this meta-analysis demonstrated that the acupuncture group had a lower adverse reaction rate compared with the control group(12 trials,n=860,I^2=0%;relative risk(RR)0.37,95%CI 0.26 to0.53;P<0.00001).The acupuncture group was lower than control group in SERS scores before and after treatment in 2、4、6、8 weeks.(n=691,I^2=0%,WMD=2.42,95%CI 2.00 to 2.84).Conclusions Current evidence shows that electro-acupuncture or acupuncture combined with SSRIs is effective over the first 1-week,2-week,4-week,6-week and 8-week treatment period.Moreover,this treatment combination appears to result in greater therapeutic efficacy and lower adverse reactions than antidepressant medication therapy alone.