基于多水平统计模型评价针灸治疗原发性抑郁症的疗效及干预层次
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摘要
目的建立多水平统计模型,定量评价针灸治疗原发性抑郁症的疗效及干预层次,并探讨其与Meta分析结果的异同。方法检索数据库,纳入针灸治疗原发性抑郁症文献,首先构建评价针灸疗效的拟合对数事件发生率线性模型,运用MLwi N 2.26软件拟合结果,建立不同干预方式为指示变量的组合模型,以评价不同针灸干预方式对整体疗效影响程度。并对上述数据采用Rev Man 5.3软件进行Meta分析,比较两模型结果。结果最终纳入13项研究,多水平统计模型结果表明,单用针灸及针灸联合药物改善原发性抑郁症患者临床控制率优于药物[RR=1.54,95%CI(1.02,2.32);RR=2.14,95%CI(1.63,2.81)];Meta分析结果显示,针灸联合药物改善原发性抑郁症患者临床控制率及总有效率优于药物[RR=2.24,95%CI(1.68,2.98);RR=1.12,95%CI(1.05,1.19)]。干预方式指示变量数据模型分析结果表明,单用针灸与针灸联合药物在临床控制率、显效率及总有效率比较,差异均无统计学意义(P>0.05)。综合多水平统计模型结果,单用针灸干预临床控制率为27.97%~28.14%,临床显效率为30.36%~35.79%,临床总有效率为90.85%~91.82%;针灸联合药物干预临床控制率为36.42%~36.64%,临床显效率为38.52%~38.84%,临床总有效率为90.91%~93.58%。结论多水平统计模型方法可评价针灸疗效及干预层次,支持针灸疗效的高质量证据充分,较Meta分析结果更为准确。
Objective To establish a multilevel statistical model,quantitatively evaluate therapeutic effect and intervention level of acupuncture and moxibustion treating primary depression and study the similarities and differences between above results and the results of Meta analysis. Methods The researchers retrieved database to collect literatures acupuncture and moxibustion treating primary depression. First of all,the researchers constructed linear model with incidence rate of fitting logarithmic event that evaluated therapeutic effect of acupuncture and moxibustion. They used software MLwi N 2. 26 to fit results for establishing combined model with different interventions as indicator variable. The researchers established the model to evaluate incidence to curative effect of different intervention with acupuncture and moxibustion. Then they used Rev Man 5. 3 software to make Meta analysis to above data and compared the results between the two models. Results Eventually 13 studies were brought into this research. Results of multilevel statistical model showed acupuncture and moxibustion or the two combined with medicine can better improve clinical control rate of patients with primary depression compared with only medicine [RR = 1. 54,95% CI( 1. 02,2. 32); RR = 2. 14,95% CI( 1. 63,2. 81) ]. Results of Meta analysis showed acupuncture and moxibustion combined with medicine can better improve clinical control rate and total effective rate of patients with primary depression compared with only medicine [RR = 2. 24,95% CI( 1. 68,2. 98); RR = 1. 12,95% CI( 1. 05,1. 19) ]. Results of data model with interventions as indicator variable showed that there were no statistically significant difference in clinical control rate,effective rate and total effective rate between only acupuncture and moxibustion and acupuncture and moxibustion combined with medicine( P > 0. 05). Collecting results of multilevel statistical model,clinical control rate that intervened with acupuncture and moxibustion was 27. 97%- 28. 14%,however clinical effective rate was30. 36%- 35. 79% and clinical total effective rate was 90. 85%- 91. 82%. Clinical control rate that intervened with acupuncture and moxibustion combined with medicine was 36. 42%- 36. 64%,however clinical effective rate was38. 52%- 38. 84% and clinical total effective rate was 90. 91%- 93. 58%. Conclusion The method of multilevel statistical model may evaluate therapeutic effect of acupuncture and moxibustion and intervention level. It has sufficient evidence to support quality therapeutic effect of acupuncture and moxibustion,and is more accurate than results of Meta analysis.
Objective To establish a multilevel statistical model,quantitatively evaluate therapeutic effect and intervention level of acupuncture and moxibustion treating primary depression and study the similarities and differences between above results and the results of Meta analysis. Methods The researchers retrieved database to collect literatures acupuncture and moxibustion treating primary depression. First of all,the researchers constructed linear model with incidence rate of fitting logarithmic event that evaluated therapeutic effect of acupuncture and moxibustion. They used software MLwi N 2. 26 to fit results for establishing combined model with different interventions as indicator variable. The researchers established the model to evaluate incidence to curative effect of different intervention with acupuncture and moxibustion. Then they used Rev Man 5. 3 software to make Meta analysis to above data and compared the results between the two models. Results Eventually 13 studies were brought into this research. Results of multilevel statistical model showed acupuncture and moxibustion or the two combined with medicine can better improve clinical control rate of patients with primary depression compared with only medicine [RR = 1. 54,95% CI( 1. 02,2. 32); RR = 2. 14,95% CI( 1. 63,2. 81) ]. Results of Meta analysis showed acupuncture and moxibustion combined with medicine can better improve clinical control rate and total effective rate of patients with primary depression compared with only medicine [RR = 2. 24,95% CI( 1. 68,2. 98); RR = 1. 12,95% CI( 1. 05,1. 19) ]. Results of data model with interventions as indicator variable showed that there were no statistically significant difference in clinical control rate,effective rate and total effective rate between only acupuncture and moxibustion and acupuncture and moxibustion combined with medicine( P > 0. 05). Collecting results of multilevel statistical model,clinical control rate that intervened with acupuncture and moxibustion was 27. 97%- 28. 14%,however clinical effective rate was30. 36%- 35. 79% and clinical total effective rate was 90. 85%- 91. 82%. Clinical control rate that intervened with acupuncture and moxibustion combined with medicine was 36. 42%- 36. 64%,however clinical effective rate was38. 52%- 38. 84% and clinical total effective rate was 90. 91%- 93. 58%. Conclusion The method of multilevel statistical model may evaluate therapeutic effect of acupuncture and moxibustion and intervention level. It has sufficient evidence to support quality therapeutic effect of acupuncture and moxibustion,and is more accurate than results of Meta analysis.
引文
[1]HARVEY GOLDSTEIN.Multilevel Statistical Models[M].4 Edition.UK:John Wiley&Sons,2011.
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[3]HIGGINS J,GREEN S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[EB/OL].(2011-03)[2015-07-30].http://www.cochrane-handbook.org.
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[6]樊莉,符文彬,蒙昌荣,等.应用汉密顿抑郁量表评估正穴位与非穴位针刺治疗抑郁性神经症的疗效[J].中国临床康复,2005,9(28):14-16.
[7]赵少廉.电针治疗抑郁症的临床与作用机制研究[D].广州:广州中医药大学,2005.
[8]段冬梅,图娅,陈利平.电针与百优解对伴躯体症状抑郁症有效性的评价[J].中国针灸,2008,28(3):167-170.
[9]徐薇.调神解郁针刺法治疗肝气郁结型抑郁症的临床研究[D].哈尔滨:黑龙江中医药大学,2010.
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[11]黄昕,陈伊,石朗.针刺对抑郁症患者脑电图及疗效影响的临床研究[J].中医药学报,2012,40(2):55-58.
[12]李光海,耿寅卯,张素娟,等.头针配合药物治疗抑郁症的疗效观察[J].针灸临床杂志,2006,22(5):27-28.
[13]姜晓岩,任凯,赵希武.针灸结合西酞普兰治疗抑郁症34例[J].针灸临床杂志,2008,24(12):18-19.
[14]DUAN DM,TU Y,JIAO S,et al.The Relevance between Symptoms and Magnetic Resonance Imaging Analysis of the Hippocampus of Depressed Patients Given Electro-acupuncture Combined with Fluoxetine Intervention:A Randomized Controlled Trial[J].Chin J Integr Med,2011,17(3):190-199.
[15]马学红,王向群,黄文升,等.电针对盐酸帕罗西汀治疗轻中度抑郁症患者增效减毒作用的临床研究[J].中华中医药杂志,2011,26(12):2876-2879.
[16]陈丽智.针药结合治疗抑郁症的远期疗效观察[D].南京:南京中医药大学,2011.
[17]林燕红,王玲玲.电针与传统针刺治疗抑郁症的临床对照研究[J].上海针灸杂志,2012,31(2):77-79.
[18]LARRY V.HEDGES,INGRAM OLKIN.Statistical Methods for Meta-Analysis[M].Orlando:Academic Press,1985.
[2]HAMILTON MA.A rating scale for depression[J].J Neurol Surgery Psyehiatry,l960,23:56-62.
[3]HIGGINS J,GREEN S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[EB/OL].(2011-03)[2015-07-30].http://www.cochrane-handbook.org.
[4]JADAD AR,MOORE RA,CARROLL D.Assessing the quality of reports of randomized clinical trials:is blinding necessary?[J].Control Clin Trials,1996,17(1):1-12.
[5]杨珉,李晓松.医学和公共卫生研究常用多水平统计模型[M].北京:北京大学医学出版社,2007:137-145.
[6]樊莉,符文彬,蒙昌荣,等.应用汉密顿抑郁量表评估正穴位与非穴位针刺治疗抑郁性神经症的疗效[J].中国临床康复,2005,9(28):14-16.
[7]赵少廉.电针治疗抑郁症的临床与作用机制研究[D].广州:广州中医药大学,2005.
[8]段冬梅,图娅,陈利平.电针与百优解对伴躯体症状抑郁症有效性的评价[J].中国针灸,2008,28(3):167-170.
[9]徐薇.调神解郁针刺法治疗肝气郁结型抑郁症的临床研究[D].哈尔滨:黑龙江中医药大学,2010.
[10]刘克新.疏肝调神法针刺治疗抑郁症的临床观察[D].哈尔滨:黑龙江中医药大学:2011.
[11]黄昕,陈伊,石朗.针刺对抑郁症患者脑电图及疗效影响的临床研究[J].中医药学报,2012,40(2):55-58.
[12]李光海,耿寅卯,张素娟,等.头针配合药物治疗抑郁症的疗效观察[J].针灸临床杂志,2006,22(5):27-28.
[13]姜晓岩,任凯,赵希武.针灸结合西酞普兰治疗抑郁症34例[J].针灸临床杂志,2008,24(12):18-19.
[14]DUAN DM,TU Y,JIAO S,et al.The Relevance between Symptoms and Magnetic Resonance Imaging Analysis of the Hippocampus of Depressed Patients Given Electro-acupuncture Combined with Fluoxetine Intervention:A Randomized Controlled Trial[J].Chin J Integr Med,2011,17(3):190-199.
[15]马学红,王向群,黄文升,等.电针对盐酸帕罗西汀治疗轻中度抑郁症患者增效减毒作用的临床研究[J].中华中医药杂志,2011,26(12):2876-2879.
[16]陈丽智.针药结合治疗抑郁症的远期疗效观察[D].南京:南京中医药大学,2011.
[17]林燕红,王玲玲.电针与传统针刺治疗抑郁症的临床对照研究[J].上海针灸杂志,2012,31(2):77-79.
[18]LARRY V.HEDGES,INGRAM OLKIN.Statistical Methods for Meta-Analysis[M].Orlando:Academic Press,1985.