Systematic Review Of Acupuncture In The Treatment Of Post-Stroke Depression

Purpose:To evaluate the efficacy and safety of acupuncture intervention in stroke depression.Methods:The study subjects were post-stroke depression patients,the intervention measures were acupuncture,the control group was conventional western medicine treatment,the specific drugs included selective serotonin reuptake inhibitors(SSRI,fluoxetine hydrochloride),tricyclic(amitriptyline),tetracyclic(maprotiline),monoamine oxidase inhibitors(moclobemide).The main outcome measures were HAMD score,effective rate and cure rate.Develop Chinese and English retrieval strategies,retrieve domestic databases China biology medicine disc(CBM),China Knowledge Network(CNKI),Wanfang database;foreign databases Pub Med,EMBASE and Cochrane Library,browse the title and summary,read the full text if necessary,and conduct preliminary screening,which are determined by two researchers and finally included in the literature.In case of disagreement,it shall be coordinated by a third party.According to the characteristics of the literature,the data were extracted,including the research object,intervention/control measures,and the specific content of outcome indicators.At the same time of literature extraction,the bias risk assessment tool introduced in Cochrane Handbook is used for literature quality assessment.Revman 5.3 software was used for statistical analysis:continuous data were represented by weighted mean difference(WMD)and standardized mean difference(SMD);secondary data were represented by relative risk(RR)and ODS ratio(or),95%confidence interval(CI).When data consolidation analysis is needed,firstly,heterogeneity test shall be carried out.When I2?50%,it can be considered that the included independent research has homogeneity,and then random effects model(RE)shall be used to calculate the analysis statistics;when I2>50,it can be considered that the included research has heterogeneity,and sensitivity analysis or subgroup analysis can be used for processing.RESULTS:1. Literature results:a total of 1177 literatures were retrieved,including 14articles,3 foreign literatures and 11 Chinese literatures.A total of 1640 patients with post-stroke depression were included,all of them were outpatients or inpatients in local hospitals,including 809 male patients and 831 female patients,aged between 18and 79 years,and the course of disease ranged from 0.5 months to 26 years.The course of intervention was 4-24 weeks.The intervention measures were acupuncture,while the control measures were antidepressant drugs or common drugs.Adverse reactions were described in five articles.According to the bias risk assessment tool,all the selected literatures were of uncertain bias risk.2.Analysis results:(1)main evaluation index:HAMD score:before the combined effect analysis,heterogeneity test was carried out first,and the results showed that I~2=90%,P<0.00001,which indicated that there was significant heterogeneity in the above 14 literatures.Then,subgroup analysis was carried out in this study,which was divided into 4 weeks according to the course of disease(Wang Weihua 2011,Tang Yongxiang 2011,sun Jianhua 2013,Kong Xiangyan 2015,Xie Yan)Long 2017,Aiwen Chen 2018),6 weeks(Li Hongjie 2011),8 weeks(Wuyun2011,Zhou Yuan 2012,Wei Bo 2013,song Shuchang 2014,Jiaping Wu 2010,Huang Wenxiong 2017),24 weeks(Yuning sun 2015).The results of 4-week treatment showed that:MD=-5.99,CI was[-9.29,-2.69],z=3.56(P=0.0004)was obtained through z-search;MD=0.80,CI was[-3.01,4.61],z=0.41(P=0.68)was obtained through z-search;MD=-3.22,CI was[-4.34,-2.10]were obtained through z-search,Finally,z=5.65,P<0.00001);24 weeks of research results showed that:MD=-2.08,CI was[-4.23,0.07],through Z retrieval,the final z=1.89(P=0.06).All the combined research results showed that:MD=-4.12,CI was[-5.49,-2.76],the data showed that the acupuncture group was better than the western medicine group.(2)Secondary outcome measures:(1)effective rate:a total of 11 literatures(Zhou Yuan2012,Wang Weihua 2011,Li Hongjie 2011,Tang Yongxiang 2011,Wei Bo 2013,sun Jiaohua 2013,song Shuchang 2013,Xie Yanlong 2017,Huang Wenxiong 2017,Yunting sun 2015,Jiaping Wu)were included in the study 2010)included the relevant research analysis,and used the counting data dichotomy method in the follow-up analysis.Based on this research analysis,the relevant results were obtained through meta-analysis.Among them,I~2=0%,which shows the homogeneity between different research literatures.After calculation and combination,the RR value was1.13,and CI was[1.08,1.17].After z-search,z=5.51(P<0.00001)was finally obtained.The conclusion is as follows:there is statistical significance between the acupuncture group and the drug group to compare the effective rate.(2)Cure rate:a total of 9 studies(Zhou Yuan 2012,Wang Weihua 2011,Tang Yongxiang 2011,Wei Bo 2013,sun Zhonghua 2013,song Shuchang 2013,Xie Yanlong 2017,Huang Wenxiong 2017,Jiaping Wu 2010)were included for relevant research and analysis,and relevant results were obtained through statistical analysis.Among them,I~2=14%,which shows the homogeneity between different research literatures.After calculation and combination,the RR value was 1.48,and CI was[1.23,1.78].After z-search,z=4.16(P<0.0001).We can draw the following conclusion:the difference of cure rate between acupuncture group and drug group is statistically significant.(3)Because of its safety and low side effects,acupuncture should be better promoted.(4)In this study,we found that despite the establishment of relatively strict inclusion and exclusion criteria,the quality of clinical randomized controlled trials is still unsatisfactory.It is suggested that strict requirements should be made in the future to improve the accuracy,rationality and feasibility of the trial.Conclusion:1.Acupuncture intervention in patients with post-stroke depression is better than conventional western medicine in improving HAMD score,and the curative effect of acupuncture intervention on post-stroke depression is better than that of conventional western medicine.2. The number of adverse reactions of acupuncture in the treatment process is lower than that of common western medicine treatment.The safety of acupuncture in the treatment of post-stroke depression is worth affirming to a certain extent.3. At present,the quality of the included literature is low,and the reliableconclusion of acupuncture intervention on post-stroke depression is not available.