针刺和艾灸治疗恶性肿瘤患者伴心理症状失眠、焦虑和抑郁：系统评价和 Meta 分析。
Acupuncture and moxibustion for malignant tumor patients with psychological symptoms of insomnia, anxiety and depression: a systematic review and Meta-analysis.
机构信息
Department of Acupuncture-Moxibustion, Tuina and Rehabilitation, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, China.
Traditional Chinese Medicine Department, the First Affiliated Hospital of Soochow University, Suzhou 215006, China.
出版信息
J Tradit Chin Med. 2023 Jun;43(3):441-456. doi: 10.19852/j.cnki.jtcm.20230313.001.
OBJECTIVE
To evaluate the efficacy and safety of acupuncture and moxibustion therapy (AMT) for cancer-related psychological symptoms (CRPS) of insomnia, depression and anxiety.
METHODS
Seven databases were searched for randomized controlled trials (RCT) comparing AMT to routine care or conventional drug for alleviating CRPS of insomnia, depression, and anxiety before April 2020. Two independent reviewers performed the data extraction and assessed the risk of bias.
RESULTS
A total of 30 RCTs involving 2483 cancer patients were enrolled. The pooled analysis indicated that the treatment group was significantly better than the control group in improving the depression effective rate [= 1.29, 95% (1.12, 1.49), 0.0004], the quality of life (QOL) [1.11, 95% (0.80, 1.42), 0.000 01], and reducing Self-rating Anxiety Scale (SAS) [﹣7.75, 95% (﹣10.44, ﹣5.05), 0.000 01]. But there was no statistically significant difference between two groups in improving the insomnia effective rate [= 1.18, 95% (0.93, 1.51), 0.18]. The subgroup analysis showed the effectiveness of different intervention on CRPS. Compared with routine care, AMT helps relieve CRPS better evaluated by Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Scale (HAMD), and Self-rating Depression Scale (SDS), and depression effective rate. Compared with conventional drug, AMT performs better evaluated by SDS, depression effective rate and QOL. Moreover, the conventional drug showed higher treatment efficacy on improving insomnia effective rate compared with AMT. Compared to conventional drug, AMT plus conventional drug resulted in a significant reduction on CRPS such as PSQI, HAMD, SDS, and SAS, and also had a meaningful improvement on insomnia effective rate, depression effective rate and QOL. Fewer published reports were found on the adverse events of AMT than the conventional drug.
CONCLUSION
The results suggested that AMT might be effective in improving CPRI; however, a definite conclusion could not be drawn because the quality of trials are low. Further large-scale and high-quality RCTs to verify the efficacy and safety of AMT on CRPS are still warranted.
目的
评估针灸治疗癌症相关心理症状（CRPS）失眠、抑郁和焦虑的疗效和安全性。
方法
检索了截至 2020 年 4 月比较针灸与常规护理或常规药物治疗缓解失眠、抑郁和焦虑的 CRPS 的随机对照试验（RCT）。两名独立的审查员进行了数据提取和偏倚风险评估。
结果
共纳入 30 项 RCT，涉及 2483 例癌症患者。汇总分析表明，治疗组在改善抑郁有效率[=1.29，95%（1.12，1.49），0.0004]、生活质量（QOL）[1.11，95%（0.80，1.42），0.00001]和降低自评焦虑量表（SAS）[﹣7.75，95%（﹣10.44，﹣5.05），0.00001]方面明显优于对照组。但两组在改善失眠有效率方面无统计学差异[=1.18，95%（0.93，1.51），0.18]。亚组分析显示不同干预措施对 CRPS 的疗效。与常规护理相比，针灸在匹兹堡睡眠质量指数（PSQI）、汉密尔顿抑郁量表（HAMD）和自评抑郁量表（SDS）和抑郁有效率评估中更有助于缓解 CRPS；与常规药物相比，针灸在 SDS、抑郁有效率和 QOL 评估中表现更好。此外，常规药物在改善失眠有效率方面的疗效高于针灸。与常规药物相比，针灸联合常规药物可显著降低 PSQI、HAMD、SDS 和 SAS 等 CRPS，且对失眠有效率、抑郁有效率和 QOL 有明显改善。与常规药物相比，针灸的不良反应报道较少。
结论
结果表明针灸可能有助于改善 CRPS，但由于试验质量较低，不能得出明确的结论。需要进一步开展大规模、高质量的 RCT 来验证针灸治疗 CRPS 的疗效和安全性。
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