中国神经再生研究(英文版)

中国神经再生研究(英文版)

• 原著:脑损伤修复保护与再生 • 上一篇    

早期毫针针刺治疗脑卒中后抑郁状态：17个随机对照临床试验的meta分析

  

  • 收稿日期:2014-02-23 出版日期:2014-04-15 发布日期:2014-04-15
  • 基金资助:

    广东省“211工程”三期重点学科建设项目(粤2009431号)

Early filiform needle acupuncture for poststroke depression: a meta-analysis of 17 randomized controlled clinical trials

Jiping Zhang, Jing Chen, Junqi Chen, Xiaohui Li, Xueyan Lai, Shaoqun Zhang, Shengxu Wang   

  1. Staff Room of Acupuncture, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
  • Received:2014-02-23 Online:2014-04-15 Published:2014-04-15
  • Contact: Shengxu Wang, M.D., Staff Room of Acupuncture, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China, sxwang88@126.com.

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摘要：

目的：评价毫针针刺治疗脑卒中后抑郁状态的有效性及安全性，并与抗抑郁药物治疗效果进行比较。
资料来源：运用计算机检索中国知网(CNKI，1979-2012)、中国万方数据库(Wanfang，1980-2012)、中国维普期刊数据库(VIP，1989-2012)、中国生物医学文献数据库(CBM，1975-2012)、PubMed数据库(1966-2012)、Ovid Lww数据库(-2012)、Cochrane 图书馆(-2012)。
资料选择：纳入毫针针刺与抗抑郁药对照治疗脑卒中后抑郁症的随机对照试验，且Jadad量表评分≥4分的文献；排除其他针刺疗法为治疗组，研究对象为非脑卒中后抑郁症患者，质量学评价<4分及非随机对照文献和动物实验文献。
结局评价指标：汉密顿抑郁量表评分、临床有效率、Zung氏抑郁自评量表评分、Asberg氏抗抑郁剂不良反应量表评分、不良反应事件发生率。
结果：共纳入17个随机对照临床试验。Meta分析结果显示，治疗4周后，毫针针刺法对脑卒中后抑郁症患者抑郁状态改善的临床有效率优于较单纯抗抑郁药 (RR=1.11, 95%CI: 1.03-1.21, P=0.01)；治疗6周后，两种疗法的临床有效率相近。毫针治疗2周后，脑卒中后抑郁症患者汉密顿抑郁量表(17项)评分低于抗抑郁药组(MD=-2.34，95%CI：-3.46-¬¬ -1.22, P<0.0001)，治疗4周后，两组汉密顿抑郁量表(24项)评分相近。两种疗法的抑郁自评量表评分均为毫针针刺疗法Zung氏抑郁自评量表评分低于抗抑郁药组。所有文献中只有2篇文献使用了Asberg量表评估，未进行meta分析。对17个研究进行安全性评价显示，抗抑郁药组的恶心、呕吐等胃肠道反应较常见，毫针针刺组几乎无不良反应, 毫针针刺组不良反应发生率较低。
结论：在脑卒中后抑郁症的治疗中，早期应用毫针针刺治疗，可以更好地控制患者的抑郁状态，疗效安全可靠，效果优于抗抑郁药物治疗。
 
 

关键词: 神经再生, 脑损伤, 脑卒中后抑郁症, 毫针针刺疗法, 抗抑郁药, 随机对照试验, 临床有效率, 安全性, meta分析, 系统评价

Abstract:

OBJECTIVE: To evaluate the effectiveness and safety of filiform needle acupuncture for poststroke depression, and to compare acupuncture with the therapeutic efficacy of antidepressant drugs.
DATA RETRIEVAL: We retrieved data from the Chinese National Knowledge Infrastructure (1979–2012), Wanfang (1980–2012), VIP (1989–2012), Chinese Biomedical Literature (1975–2012), PubMed (1966–2012), Ovid Lww (–2012), and Cochrane Library (–2012) Database using the internet.
SELECTION CRITERIA: Randomized controlled trials on filiform needle acupuncture versus antidepressant drugs for treatment of poststroke depression were included. Moreover, the included articles scored at least 4 points on the Jadad scale. Exclusion criteria: other acupuncture therapies as treatment group, not stroke-induced depression patients, score < 4 points, non-randomized controlled trials, or animal trials.
MAIN OUTCOME MEASURES: These were the Hamilton Depression Scale scores, clinical effective rate, Self-Rating Depression Scale scores, Side Effect Rating Scale scores, and incidence of adverse reaction and events.
RESULTS: A total of 17 randomized controlled clinical trials were included. Meta-analysis results displayed that after 4 weeks of treatment, clinical effective rate was better in patients treated with filiform needle acupuncture than those treated with simple antidepressant drugs [relative risk  = 1.11, 95% confidence interval (CI): 1.03–1.21, P = 0.01]. At 6 weeks, clinical effective rate was similar between filiform needle acupuncture and antidepressant drug groups. At 2 weeks after filiform needle acupuncture, Hamilton Depression Scale (17 items) scores were lower than in the antidepressant drug group (mean difference = −2.34, 95%CI: −3.46 to −1.22, P < 0.000,1). At 4 weeks, Hamilton Depression Scale (24 items) scores were similar between filiform needle acupuncture and antidepressant drug groups. Self-Rating Depression Scale scores were lower in filiform needle acupuncture group than in the antidepressant drug group. Side Effect Rating Scale was used in only two articles, and no meta-analysis was conducted. Safety evaluation of the 17 articles showed that gastrointestinal tract reactions such as nausea and vomiting were very common in the antidepressant drug group. Incidence of adverse reaction and events was very low in the filiform needle acupuncture group.
CONCLUSION: Early filiform needle acupuncture for poststroke depression can perfectly control depression. Filiform needle acupuncture is safe and reliable. Therapeutic effects of filiform needle acupuncture were better than those of antidepressant drugs.

Key words: nerve regeneration, poststroke depression, filiform needle acupuncture, antidepressant , drugs, randomized controlled trials, clinical effective rate, safety, meta-analysis, the Guangdong , Provincial “211 Engineering&rdquo, Stage-III Key Disciplines Construction Project, neural regeneration

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