针刺治疗抑郁失眠共病随机对照试验的系统评价

发布时间：2018-03-20 13:58

本文选题：针刺　切入点：抑郁　出处：《黑龙江中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过循证医学系统评价与Meta分析的方法,以既往文献为检索对象,对针刺治疗抑郁失眠共病的治疗效果和安全性进行评价,为临床针刺治疗抑郁失眠共病提供循证医学依据。同时,对针刺治疗抑郁失眠共病随机对照试验的设计及在方法学方面存在的问题进行探讨,以初步探索影响针刺治疗抑郁失眠共病疗效评价的相关因素,提高临床研究质量,为今后针刺治疗抑郁失眠共病随机对照试验的方案设计、数据分析及研究评价提供参考意见。方法:根据考科兰(Cochrane)提供的系统综述研究方法,制定科学的、有效的检索策略,对所有文献进行检索并纳入符合标准的研究,对其做以资料数据提取、方法学质量评价及结局指标报告与讨论。检索方法与筛选方法:采用计算机、手工等方式对电子数据库和期刊杂志中的期刊文献、学位论文以及灰色文献等进行检索,计算机检索电子数据库分别为 Web of Science、Medline via Pubmed、Cochrane Library、Embase、Psycinfo、ICTRP、Clinical Trails、中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP)、万方数据库(WANFANG);手工检索期刊杂志分别为《中国针灸》、《针刺研究》、《针灸临床杂志》和《上海针灸杂志》;另外,通过科技论文在线和Open Grey实现灰色文献的检索。检索日期均从建库到2016年12月30日。检索内容同时包含"针刺"、"抑郁"、"失眠"三方面的随机对照试验,首先,利用EndNoteX7文献管理软件除重,其次,根据文献的纳入、排除标准,通过阅读标题、摘要及全文,最终筛选出符合纳入标准的研究。数据提取与质量评价:资料的数据提取与质量评价,均由两名评价员独立完成,后交叉核对,如判断不一,可通过讨论或第三方裁定,所有数据结果均以表格形式呈现。对于纳入文献的方法学质量评价,我们采用偏倚风险评价工具(risk of bias tool)。统计学分析使用RevMan5.3软件和Stata14.0软件的Meta分析模块。对异质性的评估,我们不仅采用I2统计量检验,还进行χ2和它的P值检验;报告偏倚,若纳入的文献数量多于10个,则制作漏斗图对偏倚风险进行评估,但由于目测漏斗图主观性较强,对偏倚风险的检验效能较低,所以我们同时使用Stata进行客观化较强的Egger检验;在数据合并上,当I2低于50%时,采用固定效应模型,当I2大于50%时,采用随机效应模型。结局指标:主要结局指标包括抑郁评价和失眠评价的双方面指标,抑郁评价采用汉密尔顿量表(HAMD)或抑郁自测量表(SDS);失眠评价采用匹兹堡量表(PSQI)。不限量表版本,如HAMD-17,HAMD-21或HAMD-24 均可。结果:通过文献检索,获取文献题目、摘要共575篇,其中英文文献418篇,中文文献157篇。利用EndNoteX7软件逐层剔除文献,最终纳入文献11篇,包括英文文献2篇,中文期刊论文9篇,共计患者906例。Meta分析显示,大部分独立试验都报告了显著的治疗效果,但是部分Meta分析的结果异质性较高,虽然通过亚组分析和敏感性分析对异质性来源进行了多角度探索,但多项Meta分析难以找到确切的异质性来源。结论:1.针刺治疗抑郁失眠共病疗效肯定,并具有安全性。2.针刺对抑郁失眠共病的随机对照试验研究有待进一步规范。
[Abstract]:Objective: through the analysis and evaluation method of Meta based medicine system, according to the past literature to retrieve the object, evaluate the therapeutic effect and safety of acupuncture treatment of insomnia depression comorbidity, provide a basis for clinical acupuncture treatment of insomnia depression comorbidity. At the same time, the existing methods in design of common disease in randomized controlled trials and the acupuncture treatment of insomnia and depression are discussed, in order to explore the influence factors related to evaluation of the therapeutic effect of acupuncture on depression comorbid insomnia, improve the quality of clinical research, for the future design of acupuncture treatment of insomnia depression comorbidity of randomized controlled trials provide the reference scheme, analysis and Research on the evaluation data. Methods: according to the test (Corran Cochrane a review of research methods provided by the system), formulate a scientific, effective search strategies for all literature retrieval and research into standard, the data to do Data extraction method, report and discussion evaluation and outcome quality. The retrieval methods and screening methods using computer and manual methods on electronic databases and journals in journals, dissertations and grey literature retrieval and computer retrieval, electronic databases were Web of Science, Medline via Pubmed, Cochrane Library, Embase Psycinfo, ICTRP, Clinical, Trails, Chinese HowNet (CNKI), Chinese biomedical literature database (CBM), VIP database (VIP), Wanfang database (WANFANG); manual retrieval journals were China < < > > of acupuncture, acupuncture, acupuncture clinical magazine < > and < > in Shanghai Journal of acupuncture and moxibustion; and retrieve the grey literature by sciencepaper online and Open Grey. The retrieval date from inception to December 30, 2016. At the same time to retrieve the content contains "needle", "depression", "random for insomnia" in three aspects According to the test, first of all, using the EndNoteX7 document management software in addition, secondly, according to the inclusion, exclusion criteria, through reading the title, abstract, selected studies that met the inclusion criteria. Data extraction and quality assessment, data extraction and quality evaluation data, by two reviewers independently, after cross check, such as one judgment, through discussion or the third party ruling, all the data are presented in tabular form. For the methodological quality evaluation, we use the bias risk assessment tool (risk of bias tool). Statistical analysis using RevMan5.3 software and Stata14.0 Meta evaluation of the heterogeneity analysis module., we not only use I2 statistic test, also was 2 and its P value test; reporting bias, if more than 10 of the number of documents included, making the risk of bias was evaluated by funnel plot, but In the visual inspection of funnel plots of subjectivity, effectiveness of the low risk of bias, so we use Stata objective strong Egger test; in the data merge, when the I2 is lower than 50%, using fixed effect model, when more than 50% I2, using a random effects model. Main outcome measures: outcomes included double evaluation and evaluation index of depression insomnia, depression evaluation using the Hamilton scale (HAMD) and depression self testing scale (SDS); insomnia evaluation by Pittsburgh scale (PSQI). No limit table version, such as HAMD-17, HAMD-21 or HAMD-24 can. Results: through literature retrieval, document title, abstract a total of 575 English, of which 418 literatures, Chinese 157 literatures. By deleting documents using EndNoteX7 software, finally 11 articles were included, including English 2 literatures, Chinese journal 9 papers, a total of 906 patients of.Meta analysis showed that the most Independent tests have reported significant therapeutic effect, but the results of Meta analysis with high heterogeneity, although by subgroup analysis and sensitivity analysis of the multi angle to explore the sources of heterogeneity, but the number of Meta analysis is difficult to find the exact sources of heterogeneity. Conclusion: 1. acupuncture treatment of insomnia depression comorbidity and curative effect. A randomized controlled trial of acupuncture on Depression Insomnia safety.2. comorbidity should be further standardized.

【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.6

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