Department of Cadre Health Care, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Blood Purification Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Ann Palliat Med. 2020 Jul;9(4):1886-1895. doi: 10.21037/apm-20-974. Epub 2020 Jun 10.
Our study aims to evaluate the clinical efficacy and quality of life of cognitive-behavioral therapy (CBT) for patients who have acute coronary syndrome (ACS) with anxiety and depression.
The databases of PubMed, Cochrane, and Web of science, as well as China journal full-text database, Wanfang database, and Weipu database, were systematically searched from the establishment of the database to February 29, 2020. The total effective rate of qualitative data was evaluated with a relative risk (RR) and 95% confidence interval (CI), and the quantitative data was evaluated with a standard mean difference (SMD) and 95% CI. Randomized controlled clinical trials of CBT for ACS were included. The RevMan5.3 and R3.5.1 software was used to analyze.
A total of 11 papers, including 1,259 patients, were included, including 639 patients in the CBT group and 620 in the control group. One article reported the total effective rate after three months of treatment with an RR of 1.48 (95% CI: 1.07, 2.06). A total of 3 articles reported the incidence of cardiovascular adverse events using the fixed effects model (I2 =41%), and the incidence of cardiovascular adverse events in the CBT group was 0.39 times lower than that in the control group (95% CI: 0.2, 0.77). A total of 11 articles reported the score of depression using the random effects model (I2 =93%), and the score of depression in the CBT group was significantly lower than that in the control group, with an SMD of -0.99 (95% CI: -1.44, -0.54). The score of anxiety was reported in 8 pieces of literature, and the randomized effect model estimated that the score of anxiety in the CBT group was significantly lower than that in the control group, with an SMD of -1.47 (95% CI: -1.98, -0.96). There was significant heterogeneity in the quality of life score, but it was not found that the quality of life score in the CBT group was significantly higher than that in the control group.
After CBT intervention, ACS patients with anxiety and depression can significantly reduce the incidence of cardiovascular adverse events and significantly reduce scores of depression and anxiety, but they have not been found to have an advantage in improving quality of life.
本研究旨在评估认知行为疗法（CBT）对伴有焦虑和抑郁的急性冠状动脉综合征（ACS）患者的临床疗效和生活质量。
系统检索了 PubMed、Cochrane、Web of science 以及中国期刊全文数据库、万方数据库和维普数据库，从数据库建立到 2020 年 2 月 29 日。采用相对风险（RR）和 95%置信区间（CI）评价定性数据的总有效率，采用标准均数差（SMD）和 95%CI 评价定量数据。纳入 CBT 治疗 ACS 的随机对照临床试验。采用 RevMan5.3 和 R3.5.1 软件进行分析。
共纳入 11 篇文献，包括 1259 例患者，CBT 组 639 例，对照组 620 例。1 篇文献报道了治疗 3 个月后的总有效率，RR 为 1.48（95%CI：1.07，2.06）。3 篇文献采用固定效应模型报道了心血管不良事件的发生率（I²=41%），CBT 组心血管不良事件的发生率为对照组的 0.39 倍（95%CI：0.2，0.77）。11 篇文献均采用随机效应模型报道了抑郁评分，CBT 组的抑郁评分显著低于对照组，SMD 为-0.99（95%CI：-1.44，-0.54）。8 篇文献报道了焦虑评分，采用随机效应模型估计 CBT 组的焦虑评分显著低于对照组，SMD 为-1.47（95%CI：-1.98，-0.96）。生活质量评分存在显著异质性，但未发现 CBT 组的生活质量评分明显高于对照组。
CBT 干预后，伴有焦虑和抑郁的 ACS 患者心血管不良事件的发生率显著降低，抑郁和焦虑评分显著降低，但在提高生活质量方面并未发现优势。
