目的: 基于目前的随机对照试验评估针灸对抑郁障碍的治疗作用。方法:检索中国知网、万方、维普、Sinomed、Pubmed、Embase等数据库后纳入针刺干预抑郁障碍的随机对照临床试验,由两名研究者按照最新《考克兰干预系统评价手册》的标准独立评价文献质量、提取数据并交叉核对,使用RevMan 5.4软件进行Meta分析。结果:共纳入52个研究,合计5277例患者。Meta分析结果显示:针灸可以改善抑郁障碍的HAMD评分和降低临床无效率{HAMD-17:WMD=-2.35,95%CI[-3.04,-1.67],P<0.00001；HAMD-24:WMD=-2.77,95%CI[-3.52,-2.03],P<0.00001; HAMD-未提及量表:WMD=-2.77,95%CI[-3.52,-2.03],P<0.00001；临床无效率:RR=0.39,95%CI[0.33,0.47],P<0.00001}。针灸还可以升高5-HT水平{SMD=1.11,95%CI[0.67,1.55],P<0.00001}。在安全性方面,针灸疗法不会增加不良事件的发生率,且可以降低TESS评分{不良事件发生率:RR=0.65,95%CI[0.47,0.89],P=0.007；TESS评分:WMD=-1.66,95%CI[-3.12,-0.20],P=0.03}。发表偏倚方面,临床无效率和不良事件可能存在发表偏倚,需要谨慎解释。结论:就目前的证据而言,针灸是一种有效而安全的治疗抑郁障碍的疗法。但尚需要更多高质量的随机对照试验以进一步验证或修改结论。

Objective: To assesse the therapeutic effect of acupuncture in depressive disorders based on current randomized controlled trials (RCTs). Method: We conducted a systematic review and meta-analysis of RCTs on acupuncture interventions for primary depression by searching databases including CNKI, Wanfang, VIP, Sinomed, PubMed, and Embase. Two researchers independently assessed the quality of the literature, extracted data according to the latest Cochrane Handbook for Systematic Reviews of Interventions, and cross-checked the data. Meta-analysis was performed using RevMan 5.4 software. Result: A total of 52 studies were included, comprising 5277 patients. The meta-analysis results showed that acupuncture significantly improved depression symptoms as measured by the Hamilton Depression Rating Scale (HAMD) and reduced clinical inefficacy rates {HAMD-17: WMD = -2.35, 95% CI [-3.04, -1.67], P < 0.00001; HAMD-24: WMD = -2.77, 95% CI [-3.52, -2.03], P < 0.00001; HAMD (unspecified scale): WMD = -2.77, 95% CI [-3.52, -2.03], P < 0.00001; Clinical inefficacy: RR = 0.39, 95% CI [0.33, 0.47], P < 0.00001}. Additionally, acupuncture increased 5-HT levels (SMD = 1.11, 95% CI [0.67, 1.55], P < 0.00001). In terms of safety, acupuncture did not increase the incidence of adverse events and reduced TESS scores {Adverse event incidence: RR = 0.65, 95% CI [0.47, 0.89], P = 0.007; TESS scores: WMD = -1.66, 95% CI [-3.12, -0.20], P = 0.03}. There is potential publication bias regarding clinical inefficacy and adverse events, necessitating cautious interpretation. Conclusion: Based on the current evidence, acupuncture is an effective and safe treatment for depressive disorders. However, more high-quality RCTs are needed to further validate or refine these conclusions.

黑龙江省中医药经典普及化专项课题项目(ZYW2023-112):基于症状学的抑郁障碍中医诊断理论研究,负责人:郝眸嘉；湖南省研究生科研创新项目(CX20230800):基于多组学联合策略探索益气活血法调控气虚血瘀证脑缺血/再灌注模型损伤模型铁死亡代谢网络图谱；负责人:杨凯麟