Liu Xuan, Zhu Fengya, Zhang Juan Li, He Zhao-Xuan, Yin Shao, Wu Ruo-Han, He Yan-Yan, Zeng Fang
Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, 611137, People's Republic of China.
Zigong First People's Hospital, Zigong, People's Republic of China.
Neuropsychiatr Dis Treat. 2025 Aug 1;21:1569-1588. doi: 10.2147/NDT.S526413. eCollection 2025.
Post-stroke depression (PSD) is a common and serious neuropsychiatric complication that requires effective treatment options. Acupuncture as an adjuvant therapy shows promise, though current systematic reviews exhibit significant discrepancies in effectiveness/safety evidence with insufficient methodological rigor.
To evaluate systematic reviews assessing acupuncture as an adjuvant therapy for PSD.
Electronic searches were conducted across eight databases from their inception to March 2024. The main search terms include "acupuncture and moxibustion therapy", "post-stroke depression" and "systematic evaluation". All systematic reviews underwent rigorous methodological evaluation employing four complementary assessment tools: AMSTAR 2 for methodological quality, ROBIS for risk of bias, PRISMA 2020 for reporting standards, and GRADE for evidence grading. The consistency level between the two reviewers is evaluated using the k-index.
Ten systematic reviews evaluated acupuncture as an adjuvant therapy for PSD. Using the AMSTAR 2 tool, 9 SRs (90%) were rated with a "very low" confidence level. According to the ROBIS criteria, only 3 SRs (30%) showed a low risk of bias. Although the report is overall comprehensive according to the PRISMA 2020 guidelines, there are significant shortcomings in areas such as evidence quality assessment (2/10, 20%). Employing the GRADE approach, 58.8% (20/34) as "very low". The reliability among evaluators is satisfactory. Acupuncture as an adjuvant therapy combined with conventional treatments significantly improved HAMD/NIHSS scores versus monotherapy.
While acupuncture as an adjuvant therapy seems to offer benefits in improving depressive symptoms and daily functioning among PSD patients, the overall low methodological quality of current systematic reviews limits the strength of this conclusion. More rigorous and high-quality evidence is needed to confirm these findings.
PROSPERO CRD 42024533181.
中风后抑郁（PSD）是一种常见且严重的神经精神并发症，需要有效的治疗方案。针灸作为一种辅助治疗方法显示出前景，尽管目前的系统评价在有效性/安全性证据方面存在显著差异，且方法学严谨性不足。
评估将针灸作为PSD辅助治疗方法的系统评价。
对八个数据库从创建到2024年3月进行电子检索。主要检索词包括“针灸疗法”“中风后抑郁”和“系统评价”。所有系统评价均采用四种互补评估工具进行严格的方法学评估：用AMSTAR 2评估方法学质量，用ROBIS评估偏倚风险，用PRISMA 2020评估报告标准，用GRADE进行证据分级。使用k指数评估两位评价者之间的一致性水平。
十项系统评价评估了针灸作为PSD辅助治疗方法的效果。使用AMSTAR 2工具，9项系统评价（90%）被评为“非常低”的置信水平。根据ROBIS标准，只有3项系统评价（30%）显示出低偏倚风险。尽管根据PRISMA 2020指南报告总体全面，但在证据质量评估等方面存在重大缺陷（2/10，20%）。采用GRADE方法，58.8%（20/34）为“非常低”。评价者之间的可靠性令人满意。与单一疗法相比，针灸作为辅助治疗与传统治疗相结合显著改善了汉密尔顿抑郁量表（HAMD）/美国国立卫生研究院卒中量表（NIHSS）评分。
虽然针灸作为辅助治疗似乎有助于改善PSD患者的抑郁症状和日常功能，但目前系统评价的总体方法学质量较低，限制了这一结论的力度。需要更严谨和高质量的证据来证实这些发现。
PROSPERO CRD 42024533181。
