针灸治疗围绝经期抑郁症有效性和安全性的系统评价

目的:评价围绝经期抑郁症针灸治疗的临床有效性和安全性。方法:收集针灸治疗围绝经期抑郁症临床研究随机对照文献,计算机检索CBM(1979-)、CNKI(1979-)、VIP(1989-)和万方数字化期刊群(1998-)、PubMed(1966-)、EMbase(1980-)和Cochrane Library,所有检索时间截至2010年10月1日,并手工检索广州中医药大学图书馆过刊资料库,而后按照Cochrane Handbook 5.0对每个纳入试验进行偏倚风险和质量评估,统计学分析采用RevMan5.0.24软件。用GRADE profiler软件和标准评估证据质量。结果:本系统评价纳入13个随机对照试验,共1057例患者,Meta分析得出针灸结合西药在有效率OR=2.76,95%CI(1.38,5.51)]和痊愈率OR=2.91,95%CI(1.82,4.65)]上都优于单纯西药治疗,但针灸与西药的比较上,无论有效率OR=1.08,95%CI(0.64,1.83)]、痊愈率OR=1.04,95%CI(0.70,1.56)]还是HAMD评分(第2周WMD=-0.35,95%CI(-3.43,2.72)];第4周WMD=0.01,95%CI(-1.96,1.98)];第6周WMD=-0.19,95%CI(-2.57,2.18)])比较差异均无统计学意义,与西药疗效相当。GRADE证据质量等级为低级。安全性方面,针灸(针灸结合西药)的不良事件发生率(1.5%)明显少于西药对照组(12.5%),显示针灸比西药治疗相对安全。结论:针灸是一种相对安全的治疗措施,不良反应较少,在结合西药治疗围绝经期抑郁症的降低HAMD评分上显示出可能有效的趋势,单纯针灸和西药疗效相当。我们仍需要进一步研究才能为临床决策提供治疗可靠的依据。

A systematic review on effect and safety of acupuncture for perimenopausal depression

Objective:To assess the effect and safety of acupuncture in the treatment for perimenopausal depression.Methods:Randomized controlled trials(RCTs) involving acupuncture for perimenopausal depression were identified from CBM(1979 to 2010),VIP(1979 to 2010),WANFANG Database(1998 to 2010),CNKI(1979 to 2010),PubMed(1966 to 2009),EMbase(1980 to 2010),and The Cochrane Library(Issue 4,2010).We also hand searched relevant journals from library of Guangzhou University of Chinese Medicine.Then assessed the quality according to Cochrane Handbook 5.0.The Cochrane Collaboration’s RevMan 5.0.24 software was used for data analyses.’GRADE profiler’ software was making the evidence classification of this system review’s evaluation results.Results:A total of 13 trials involving 1057 patients were included.Meta-analyses showed that the effective rate in the acupuncture combined with western medicine group was higher when compared with western medicineOR=1.01,95%CI(1.38,5.51)]and also the cure rateOR=2.91,95%CI(1.82,4.65)].As for acupuncture compared with western medicine,no significant difference was noted in effective rateOR=1.08,95%CI(0.64,1.83)],cure rateOR=1.04,95%CI(0.70,1.56)] and the HAMD score at week 2 WMD=-0.35,95%CI(-3.43,2.72)];at week 4WMD=0.01,95%CI-1.96,1.98)];at week 6WMD=-0.19,95%CI(-2.57,2.18)].GRADE evidence classification is very low.The incidence of adverse events of acupuncture(1.5%) was lower than western medicine group(12.5%)which showed acupuncture relatively safer than western medicine therapy.Conclusion:Acupuncture was a relative safe method with few adverse reactions.In combination with western medicine,acupuncture in the treatment of perimenopausal depression reducing HAMD rate shown potentially valid tendency,while acupuncture compared to western medicine therapy showed no statistical difference.Further researches were required to define the role of acupuncture in the treatment of perimenopausal depression neurosis.