School of Acupuncture and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
Department of Proctology, China-Japan Friendship Hospital, Beijing, China.
PLoS One. 2024 Mar 7;19(3):e0298438. doi: 10.1371/journal.pone.0298438. eCollection 2024.
To assess the effectiveness of acupuncture for treating depression and anxiety in patients diagnosed with functional dyspepsia (FD).
PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, Sinomed, and VIP Database were searched until April 30, 2023 for Randomized Controlled Trials (RCTs) comparing acupuncture to placebo or drugs for symptom alleviation. Two independent reviewers conducted the study search, data extraction, and bias risk assessment using the Cochrane Risk of Bias tool. Mean difference (MD), risk ratio (RR), and corresponding 95% confidence intervals (CI) were computed. Subgroup and sensitivity analyses were also performed. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was employed to evaluate the evidence level.
A total of 16 RCTs involving 1315 participants were included. Acupuncture demonstrated marked superiority over placebo (MD = -7.07, 95%CI: -11.03 to -3.10, very low quality evidence) in mitigating Self-Rating Anxiety Scale (SAS) scores and was found to be more effective in reducing Self-Rating Depression Scale (SDS) scores than either placebo (MD = -4.63, 95%CI: -6.28 to -2.98, low quality evidence) or first-line drugs (MD = -2.71, 95%CI: -5.19 to -0.23, very low quality evidence). In terms of attenuating Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) scores, acupuncture consistently outperformed both placebo (HAMA: MD = -2.58, 95%CI: -4.33 to -0.83, very low quality evidence; HAMD: MD = -1.89, 95%CI: -3.11 to -0.67, low quality evidence) and first-line drugs (HAMA: MD = -5.76, 95%CI: -10.18 to -1.35, very low quality evidence; HAMD: MD = -5.59, 95%CI: -7.59 to -3.59, very low quality evidence). However, no significant difference was observed between acupuncture and placebo in terms of improvement in Hospital Anxiety and Depression Scale (HADS) scores.
Based on current clinical evidence, acupuncture might have a positive effect on depression and anxiety in patients with FD. Further large-sample, multi-center, high-quality RCTs validation are required, as the conclusion is limited by the quantity and quality of the included studies.
评估针刺治疗功能性消化不良（FD）患者抑郁和焦虑的有效性。
检索 PubMed、Embase、Cochrane 图书馆、Web of Science、中国知网、万方数据、中国生物医学文献数据库和维普数据库，截至 2023 年 4 月 30 日，以比较针刺与安慰剂或药物对缓解症状的随机对照试验（RCT）。两位独立的审查员使用 Cochrane 偏倚风险工具进行研究搜索、数据提取和偏倚风险评估。使用均数差（MD）、风险比（RR）和相应的 95%置信区间（CI）计算。还进行了亚组和敏感性分析。采用推荐评估、制定与评价（GRADE）系统评估证据水平。
共纳入 16 项 RCT，涉及 1315 名参与者。与安慰剂相比，针刺在减轻焦虑自评量表（SAS）评分方面表现出显著优势（MD=-7.07，95%CI：-11.03 至-3.10，极低质量证据），且在降低抑郁自评量表（SDS）评分方面优于安慰剂（MD=-4.63，95%CI：-6.28 至-2.98，低质量证据）或一线药物（MD=-2.71，95%CI：-5.19 至-0.23，极低质量证据）。在减轻汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）评分方面，针刺始终优于安慰剂（HAMA：MD=-2.58，95%CI：-4.33 至-0.83，极低质量证据；HAMD：MD=-1.89，95%CI：-3.11 至-0.67，低质量证据）和一线药物（HAMA：MD=-5.76，95%CI：-10.18 至-1.35，极低质量证据；HAMD：MD=-5.59，95%CI：-7.59 至-3.59，极低质量证据）。然而，针刺与安慰剂在改善医院焦虑和抑郁量表（HADS）评分方面无显著差异。
基于现有临床证据，针刺可能对 FD 患者的抑郁和焦虑有积极作用。需要进一步开展大样本、多中心、高质量 RCT 验证，结论受纳入研究的数量和质量限制。
