针刺联合药物治疗围绝经期失眠的有效性和安全性：一项系统评价与Meta分析
The effectiveness and safety of acupuncture combined with medication in the treatment of perimenopausal insomnia: a systematic review and meta-analysis.
作者信息
Jiang Shengwen, Zhang Yuan, Sun Yingzhe
机构信息
School of Graduate, Heilongjiang University of Chinese Medicine, Harbin, China.
Department of Acupuncture II, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China.
出版信息
Front Neurol. 2025 Mar 13;16:1476719. doi: 10.3389/fneur.2025.1476719. eCollection 2025.
INTRODUCTION
The aim of this study is to evaluate the effectiveness and safety of the combination therapy of acupuncture and medication in the treatment of perimenopausal insomnia (PMI). This research seeks to provide scientific evidence for clinical practice, optimize treatment protocols, and enhance the sleep quality and overall quality of life for women experiencing perimenopausal insomnia.
METHODS AND ANALYSIS
A comprehensive search was conducted across 8 databases, including the China National Knowledge Infrastructure (CNKI), Wanfang Academic Journal Full-text Database (Wanfang), Chongqing VIP Database (CQVIP), China Biology Medicine Disc (CBM), PubMed, Web of Science, Excerpta Medica Database (EMBASE), and Cochrane Library, from their establishment to July 1, 2024. Outcome measures were analyzed using Review Manager 5.4 and Stata 15.0 software. The included randomized controlled trials (RCTs) involved 1,187 patients with perimenopausal sleep disorders (596 in the experimental group and 591 in the control group). The analysis indicated that compared to Western medication alone, the combination therapy showed better efficacy [risk ratio (RR) = 1.24, 95% confidence interval (CI) (1.17, 1.31), < 0.00001] and safety [RR = 0.31, 95%CI (0.18, 0.53), < 0.0001]. It also demonstrated more significant improvements in Pittsburgh Sleep Quality Index (PSQI) [mean difference (MD) = -2.77, 95%CI (-4.11, -1.43), < 0.0001], Hamilton Anxiety Rating Scale (HAMA) scores [MD = -3.45, 95%CI (-3.94, -2.97), < 0.00001], Kupperman Menopausal Index (KMI) [MD = -1.46, 95%CI (-2.23, -0.70), 0.0002], Traditional Chinese Medicine Syndromes (TCMS) scores [MD = -2.45, 95%CI (-3.85, -1.04), = 0.0006], and hormone levels, including Luteinizing Hormone (LH) [MD = -4.17, 95%CI (-7.42, -0.93), = 0.01], Follicle-Stimulating Hormone (FSH) [MD = -10.50, 95%CI (-14.80, -6.20), < 0.00001], and Estradiol (E) [MD = 12.15, 95%CI (6.79, 17.51), < 0.00001].
DISCUSSION
The combination therapy demonstrates great efficacy and safety for PMI patients, representing an innovative integrative alternative treatment with high clinical application value.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024564357, PROSPERO CRD42024564357.
引言
本研究旨在评估针灸与药物联合治疗围绝经期失眠（PMI）的有效性和安全性。本研究旨在为临床实践提供科学依据，优化治疗方案，提高围绝经期失眠女性的睡眠质量和整体生活质量。
方法与分析
对8个数据库进行全面检索，包括中国知网（CNKI）、万方学术期刊全文数据库（万方）、重庆维普数据库（维普）、中国生物医学文献数据库（CBM）、PubMed、Web of Science、荷兰医学文摘数据库（EMBASE）和Cochrane图书馆，检索时间从建库至2024年7月1日。使用Review Manager 5.4和Stata 15.0软件对结果指标进行分析。纳入的随机对照试验（RCT）涉及1187例围绝经期睡眠障碍患者（实验组596例，对照组591例）。分析表明，与单纯西药相比，联合治疗显示出更好的疗效[风险比（RR）=1.24，95%置信区间（CI）（1.17，1.31），P<0.00001]和安全性[RR=0.31，95%CI（0.18，0.53），P<0.0001]。在匹兹堡睡眠质量指数（PSQI）[平均差（MD）=-2.77，95%CI（-4.11，-1.43），P<0.0001]、汉密尔顿焦虑量表（HAMA）评分[MD=-3.45，95%CI（-3.94，-2.97），P<0.00001]、库珀曼绝经指数（KMI）[MD=-1.46，95%CI（-2.23，-0.70），P=0.0002]、中医证候（TCMS）评分[MD=-2.45，95%CI（-3.85，-1.04），P=0.0006]以及激素水平，包括促黄体生成素（LH）[MD=-4.（此处原文有误，应为4.17），95%CI（-7.42，-0.93），P=0.01]、促卵泡生成素（FSH）[MD=-10.50，95%CI（-14.80，-6.20），P<0.00001]和雌二醇（E）[MD=12.15，95%CI（6.79，17.51），P<0.00001]方面也有更显著的改善。
讨论
联合治疗对PMI患者显示出良好的疗效和安全性，是一种具有高临床应用价值的创新性综合替代疗法。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024564357，PROSPERO CRD42024564357。
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