摘要
目的评价认知行为治疗及其他干预措施对卒中后抑郁(PSD)的抗抑郁效果。方法检索PubMed、EMbase、Cochrane图书馆、中国知网、中国生物医学文献数据库,检索词包括“poststroke depression”、“cognitive behavioral therapy”、“卒中/脑卒中/中风/脑梗死”、“抑郁”以及“认知行为疗法/治疗”,排除非临床随机对照研究,时限为建库至2020年12月。统计分析方法为网状Meta分析,其中网状图与校正比较漏斗图的绘制采用STATA 14.0软件network组命令,网状关系和干预措施排序分析采用R软件的gemtc包完成。结果共纳入27项临床研究,共2560例PSD患者。与单独使用抗抑郁药物治疗相比,认知行为治疗+抗抑郁药治疗(中期效果:MD=-4.43,95%CI:-7.42~-1.43;长期效果:MD=-4.33,95%CI:-5.63~-3.06)和认知行为治疗+中药治疗(中期效果:MD=-9.48,95%CI:-15.78~-3.20;长期效果:MD=-4.46,95%CI:-7.43~-1.46)的抗抑郁效果均显著更优;与单独使用认知行为治疗治疗相比,认知行为治疗+抗抑郁药治疗(中期效果:MD=-8.88,95%CI:-16.43~-1.30;长期效果:MD=-2.87,95%CI:-4.90~-0.83)和认知行为治疗+中药治疗(中期效果:MD=-13.94,95%CI:-23.54~-4.30;长期效果:MD=-2.99,95%CI:-5.81~-0.11)的抗抑郁效果也均显著更优。单独使用认知行为治疗、抗抑郁药、中药和针灸的疗效高于抗抑郁空白对照,但彼此间的差别并不显著。不同抗抑郁干预措施的疗效排序为:(1)中期效果:认知行为治疗+中药>认知行为治疗+抗抑郁药>中药>抗抑郁药>认知行为治疗。(2)长期效果:认知行为治疗+中药,认知行为治疗+抗抑郁药,认知行为治疗+针灸>认知行为治疗>针灸>抗抑郁药>无抗抑郁对症治疗。结论对PSD患者而言,认知行为治疗结合抗抑郁药或中药治疗与单独使用抗抑郁药相比疗效更佳。
Objective To evaluate the antidepressant effect of cognitive behavioral therapy(CBT)and other interventions on post-stroke depression.Methods A systematic research in PubMed,Embase,Cochrane Library,CNKI,and China Biomedical Literature Database was conducted.The search terms included"post-stroke depression","cognitive behavioral therapy","stroke//cerebral infarction","depression"and"cognitive behavioral therapy/treatment",excluding non-clinical randomized controlled studies.The retrieval time limit was from the establishment of the database to December 2020.The statistical method was network meta-analysis,in which network plots and calibrated comparison funnel plots were drawn using the network group command of STATA14.Network relationship and intervention sequencing analysis were completed using the GEMTC package of R software.Results A total of 27 clinical studies involving 2560 patients with post-stroke depression(PSD)were included.Compared with antidepressant treatment alone,CBT combined with antidepressant treatment(med-term efficacy:-4.43,95%CI:-7.42 to-1.43;Long-term efficacy:Md=-4.33,95%CI:-5.63~-3.06)and CBT combined with traditional Chinese medicine(TCM)(midterm efficacy:Md=-9.48,95%CI:-15.78~-3.20;Long-term efficacy:MD=-4.46,95%CI:-7.43~-1.46)were significantly better.Compared with CBT alone,CBT combined with antidepressants(mid-term efficacy:-8.88,95%CI:-16.43 to-1.30;Long-term efficacy:Md=-2.87,95%CI:-4.90~-0.83)and CBT combined with traditional Chinese medicine(med-term efficacy:Md=-13.94,95%CI:-23.54~-4.30;Long-term efficacy:MD=-2.99,95%CI:-5.81~-0.11)were significantly better as well.The antidepressant effect of CBT,antidepressants,traditional Chinese medicine and acupuncture alone was superior to that of blank control,but the differences among them were not significant.The efficacy of different antidepressant interventions was ranked as follows:(1)Mid-term effects:CBT+TCM>CBT+antidepressants>TCM>antidepressants>CBT;(2)Long-term effect:CBT+traditional Chinese medicine,CBT+antidepressants,CBT+acupun
作者
孙彬
周燕玲
曾钢
Sun Bin;Zhou Yanling;Zeng Gang(The Affiliated Brain Hospital of Guangzhou Medical University,Center for Translational Medicine of Mental Disorders,Guangzhou 510370,China)
出处
《中华脑血管病杂志（电子版）》
2021年第6期407-413,共7页
Chinese Journal of Cerebrovascular Diseases(Electronic Edition)
关键词
卒中后抑郁
认知行为疗法
网状Meta分析
Post-stroke depression
Cognitive behavior therapy
Network meta analysis
