针刺治疗围绝经期情绪障碍安全性和疗效的系统评价
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摘要
目的:评价针刺对围绝经期情绪障碍的安全性和疗效。方法:检索中英文数据库至2016年10月发表的关于针刺治疗围经期情绪障碍的随机对照试验(RCT)文章,按照纳入与排除标准进行文献筛选,提取最终纳入文献数据,进行系统评价。结果:共纳入RCT文献12篇,1045例患者。Meta分析得出:针刺对于围绝经期情绪障碍有效率优于药物(Z=3.24 P=0.001),且同质性好(P=0.53,I~2=0%);针刺对于围绝经情绪障碍的HAMD评分短程(疗程≤30 d)优于药物(Z=2.81 P=0.005),长程(疗程>30 d)相当(Z=0.56,P=0.57),且存在组间异质性(P=0.11 I~2=59.9%);针刺相对于药物能够明显改善围绝经期情绪障碍Kupperman评分(Z=6.04,P<0.00001),且存在组间异质性(P=0.06,I~2=72%);针刺相对于药物能够明显改善围绝经期情绪障碍E_2含量(Z=4.26,P<0.0001),且存在组间异质性(P=0.003,I~2=88.4%);针刺对于围绝经期情绪障碍安全性优于药物(Z=7.20,P<0.00001),且同质性好(P=0.33,I~2=13%)。结论:针刺治疗围绝经期情绪障碍安全有效,但由于纳入研究在方法学和质量方面还存在一些不足之处,需要开展更多设计严谨、大样本、多中心的随机对照试验进一步支持上述结论。
Objective:To systematically evaluate the safety and effectivenss of acupuncture for women emotional disorders in perimenopause.Mothods:Through the electronic retrieval from engliash and Chinese databases,randomized controlled trial(RCT) literature regarding acupuncture treatment of women emotional disorders in perimenopause to October 2016 was collected,and they were screened according to inclusion and exclusion criteria.The included RCTs were extracted and evaluated.Methods:Results:A total of 12 RCTs were included in the analysis,involving 1045 patients.Meta-analysis results showed that acupuncture had better effective rate than medicine on women emotional disorders in perimenopause(Z=3.24 P=0.001),and best homogeneity(P=0.53,I~2=0%).Acupuncture had better efficacy than medicine on short-term HAMD score(Z=2.81,P=0.005),but long-term HAMD score was equal(Z=0.56,P=0.57),and heterogeneity existed between groups(P=0.11,I~2=59.9%).Compared with medicine,acupuncture could significantly improve the Kupperman score of women emotional disorders in perimenopause(Z=6.04,P<0.00001),and heterogeneity existed between groups(P=0.06,I~2=72%).Compared with medicine,acupuncture could significantly improve the E_2 levels of women emotional disorders in perimenopause(Z=4.26,P<0.0001),and heterogeneity existed between groups(P=0.003,I~2=88.4%).Acupuncture had better safety than medicine on women emotional disorders in perimenopause(Z=7.20,P<0.00001) and homogeneity better(P=0.33,I~2=13%).Conclusion:Acupuncture is safe and effective for women emotional disorders in perimenopause,but due to the low methodological quality of included studies,this conclusion will need to more rigorous design,large sample and multicenter RCTs to support.
Objective:To systematically evaluate the safety and effectivenss of acupuncture for women emotional disorders in perimenopause.Mothods:Through the electronic retrieval from engliash and Chinese databases,randomized controlled trial(RCT) literature regarding acupuncture treatment of women emotional disorders in perimenopause to October 2016 was collected,and they were screened according to inclusion and exclusion criteria.The included RCTs were extracted and evaluated.Methods:Results:A total of 12 RCTs were included in the analysis,involving 1045 patients.Meta-analysis results showed that acupuncture had better effective rate than medicine on women emotional disorders in perimenopause(Z=3.24 P=0.001),and best homogeneity(P=0.53,I~2=0%).Acupuncture had better efficacy than medicine on short-term HAMD score(Z=2.81,P=0.005),but long-term HAMD score was equal(Z=0.56,P=0.57),and heterogeneity existed between groups(P=0.11,I~2=59.9%).Compared with medicine,acupuncture could significantly improve the Kupperman score of women emotional disorders in perimenopause(Z=6.04,P<0.00001),and heterogeneity existed between groups(P=0.06,I~2=72%).Compared with medicine,acupuncture could significantly improve the E_2 levels of women emotional disorders in perimenopause(Z=4.26,P<0.0001),and heterogeneity existed between groups(P=0.003,I~2=88.4%).Acupuncture had better safety than medicine on women emotional disorders in perimenopause(Z=7.20,P<0.00001) and homogeneity better(P=0.33,I~2=13%).Conclusion:Acupuncture is safe and effective for women emotional disorders in perimenopause,but due to the low methodological quality of included studies,this conclusion will need to more rigorous design,large sample and multicenter RCTs to support.
引文
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[14] 岳利峰,张恒奚,胜艳,等.基于焦虑抑郁量表评价疏肝调经针灸方案治疗围绝经期情绪障碍的疗效[J].现代中医临床,2016,23(4):1-4.
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[18] 张玉泉.针刺辨证治疗围绝经期抑郁症94例临床研究[J].内蒙 古中医药,2013,23(11):41-42.
[19] 史晓岚,杨帅,王元惠,等.针药三种不同疗法对围绝经期抑郁症患者血清性激素及白细胞介素-6的影响[J].湖南中医药大学学报,2012,32(11):70-73.
[20] 迟慧,邹伟.益肾调肝针刺法治疗围绝经期抑郁症30例[J].针灸临床杂志,2011,27(7):4-7.
[21] 史晓岚,杨帅,王元惠,等.针药三种不同疗法治疗围绝经期抑郁症的临床效应分析[J].中国妇幼保健,2011,26(34):5364-5366.
[22] 郑盛惠,吴云天,廖金蓉,等.“四神针”久留针治疗围绝经期抑郁症临床研究[J].辽宁中医杂志,2010,37(4):726-728.
[23] 马静,刘忠.针刺治疗围绝经期抑郁症的临床研究[J].精神医学杂志.2009,22(4):276-278.
[24] ZHOUQing,WANG Jian-xiong.Clinical Observation on Acupuncture for Perimenopausal Depression[J]. Acupunct Tuina Sci,2009,7:200-202.
[25]周胜红.针刺治疗围绝经期抑郁症疗效观察[C].第十四届针灸对机体功能的调节机制暨针灸临床独特经验学术研讨会会议论文集,2009:52-54.
[26]唐乐.临床针刺不良反应发生情况调查研究[D].北京:北京中医药大学,2011.
[27]郭锡永,王悦,吴飞,等.更年期抑郁症状与血清单胺氧化酶活性及雌二醇水平相关性研究[J].中国妇幼保健,2005,20(10):1189.
[28]夏晓红,胡玲,秦征玉,等.电针三阴交治疗围绝经期综合征多中心随机对照研究[J].针刺研究,2008,33(8):62-266.
[29]丁艳婷.针灸治疗夜间尿次增多症的时效性研究[D].北京:北京中医药大学,2014.
[30]洪文深.针刺治疗腰椎间盘突出症35例时效性观察[D].北京:北京中医药大学,2016.
[31]陈少萍,陈卓辉,陈佩珠.口腔临床药物手册[M].广州:华南理工大学出版社,2005.
[32] Kurtoglu-Aksoy N,Akhan SE,Bastu E,et al. Implications of premature o-varian failure on bone turnover markers and bone mineral density[J]. Clin Exp Obstet Gynecol,2014,41(2):149-53.
[2] 郭锡永,王悦,吴飞,等.更年期妇女抑郁症状的发生现状及其相关因素的研究[J].中国妇幼保健,2002,17(2):100-102.
[3] 万爱华,修新红,任志伊,等.围绝经期女性抑郁焦虑症及影响因素分析[J].中国公共卫生,2007,23(3):1756.
[4] Simon JA,Reape KZ.Understanding the menopausal experi-ences of professional women[J].Menopause The Journal of The North American Menopause Society,2009,16(1):73.
[5] Ten Desschate Mo C,Koeter MW,Bockting CL,et al.Health related equality of life in recurrent depression:A com-parison with ageneral population sample[J].Affect Disord,2009,120(1):126-132.
[6] 程凯,田素领.逆针“关元”“三阴交”对去卵巢大鼠下丘脑-垂体-卵巢轴的影响[J].针刺研究,2012,37(1):15-19.
[7] 徐天舒,石明晴,韩克,等.针刺对围绝经期模型大鼠血清E2水平及下丘脑5-HT含量的影响[J].南京大学学报,2010,26(4):296 -298.
[8] 黄叶飞,符文彬,吴泰相.针灸治疗围绝经期抑郁症有效性和安全性的系统评价[J].中华中医药杂志,2011,26(5):908-914.
[9] 李昭凤,吴倩,符文彬.针灸治疗围绝经期抑郁障碍有效性和安全性的系统评价[J].中华中医药杂志,2014,29(5):1746-1752.
[10] 乐杰.妇产科学[M].7版.北京:人民卫生出版社,2007:320-322.
[11] 中华医学会精神科分会.中国精神障碍分类与诊断标准(CCMD-3)[S].3版.济南:山东科学技术出版社,2001:83-84.
[12] 上海市卫生局.上海市中医病证诊疗常规[M].上海:上海中医药大学出版社,2003:204-205.
[13] The Translation of Cochrane Handbook for Systematic Reviews of Interventions[Z].四川大学华西医院中国Cochrane中心,2014:186.
[14] 岳利峰,张恒奚,胜艳,等.基于焦虑抑郁量表评价疏肝调经针灸方案治疗围绝经期情绪障碍的疗效[J].现代中医临床,2016,23(4):1-4.
[15] 史晓岚,杨帅,张国庆,等.电针治疗围绝经期抑郁症临床观察[J].上海中医药大学学报,2009,23(5):37-39.
[16] 李海波.针刺治疗肾虛肝郁型围绝轻期抑郁症的临床观察[D].哈尔滨:黑龙江中医药大学,2015.
[17] 李昭凤.电针治疗围绝经期轻中度抑郁障碍的临床研究[D].广州:广州中医药大学,2015.
[18] 张玉泉.针刺辨证治疗围绝经期抑郁症94例临床研究[J].内蒙 古中医药,2013,23(11):41-42.
[19] 史晓岚,杨帅,王元惠,等.针药三种不同疗法对围绝经期抑郁症患者血清性激素及白细胞介素-6的影响[J].湖南中医药大学学报,2012,32(11):70-73.
[20] 迟慧,邹伟.益肾调肝针刺法治疗围绝经期抑郁症30例[J].针灸临床杂志,2011,27(7):4-7.
[21] 史晓岚,杨帅,王元惠,等.针药三种不同疗法治疗围绝经期抑郁症的临床效应分析[J].中国妇幼保健,2011,26(34):5364-5366.
[22] 郑盛惠,吴云天,廖金蓉,等.“四神针”久留针治疗围绝经期抑郁症临床研究[J].辽宁中医杂志,2010,37(4):726-728.
[23] 马静,刘忠.针刺治疗围绝经期抑郁症的临床研究[J].精神医学杂志.2009,22(4):276-278.
[24] ZHOUQing,WANG Jian-xiong.Clinical Observation on Acupuncture for Perimenopausal Depression[J]. Acupunct Tuina Sci,2009,7:200-202.
[25]周胜红.针刺治疗围绝经期抑郁症疗效观察[C].第十四届针灸对机体功能的调节机制暨针灸临床独特经验学术研讨会会议论文集,2009:52-54.
[26]唐乐.临床针刺不良反应发生情况调查研究[D].北京:北京中医药大学,2011.
[27]郭锡永,王悦,吴飞,等.更年期抑郁症状与血清单胺氧化酶活性及雌二醇水平相关性研究[J].中国妇幼保健,2005,20(10):1189.
[28]夏晓红,胡玲,秦征玉,等.电针三阴交治疗围绝经期综合征多中心随机对照研究[J].针刺研究,2008,33(8):62-266.
[29]丁艳婷.针灸治疗夜间尿次增多症的时效性研究[D].北京:北京中医药大学,2014.
[30]洪文深.针刺治疗腰椎间盘突出症35例时效性观察[D].北京:北京中医药大学,2016.
[31]陈少萍,陈卓辉,陈佩珠.口腔临床药物手册[M].广州:华南理工大学出版社,2005.
[32] Kurtoglu-Aksoy N,Akhan SE,Bastu E,et al. Implications of premature o-varian failure on bone turnover markers and bone mineral density[J]. Clin Exp Obstet Gynecol,2014,41(2):149-53.