针刺对心率变异性影响的Meta分析  

Meta Analysis of Acupuncture Effect on HRV

作　　者：张怡清[1] 温伟 杨颖[1] 程为平[1] 赤艺 刘莉[1] ZHANG Yiqing;WEN Wei;YANG Ying;CHENG Weiping;CHI Yi;LIU Li(Heilongjiang University of Chinese Medicine, Harbin 150040, China)

机构地区：[1]黑龙江中医药大学,黑龙江哈尔滨150040

出　　处：《针灸临床杂志》2021年第12期39-46,共8页Journal of Clinical Acupuncture and Moxibustion

基　　金：国家重点基础研究发展计划(973计划),编号:2014CB542903;国家自然科学基金,编号:81904107;黑龙江省自然科学基金,编号:LH2019H114。

摘　　要：目的:对针刺对心率变异性的影响进行系统评价。方法:检索PubMed、Embase、Cochrane Library、中国期刊全文数据库(CNKI)、维普中文期刊数据库(VIP)、中国生物医学文献光盘数据库(CBM disk)和万方数据库。其中纳入针刺对心率变异性影响的RCT实验。对照组采用常规标准对照。由2名研究者通过阅读文章题目和摘要,并结合全文,对文献进行资料初步提取。通过再次阅读文献全文进行分析,最终纳入16篇文献。应用Revman5.3软件对β受体阻滞剂对SDNN、RMSSD、PNN50、LF、HF、LF/HF、HR、TP和HAMD焦虑量表治疗前后改善情况进行分析。结果:SDNN(SMD:1.22%,CI=[0.31,2.14],Z=2.61,P=0.009);RMSSD(SMD:0.31%,CI=[0.09,0.54],Z=2.71,P=0.007);PNN50(MD:2.45%,CI=[1.89,3.00],Z=8.70,P<0.00001)HF(SMD:0.42%,CI=[0.14,0.70],Z=2.91,P=0.004);LF/HF的患病人群(MD:-0.37%,CI=[-0.70,-0.03],Z=2.16,P=0.03);心率(MD:-1.78%,CI=[-2.29,-0.65],Z=3.08,P=0.002),比较前后差异显示有显著性差异,表明针刺对其有显著的改善作用。而对LF(SMD:-0.56%,CI=[-1.18,0.06],Z=1.77,P=0.08)及LF/HF的健康人群(有-0.51%,CI=[-1.07,0.04],Z=1.80,P=0.07)无统计学意义,不能表明针刺对其作用。结论:针刺对心率变异性有改善作用,对迷走神经控制的PNN50、RMSSD、HF及交感神经控制的SDNN、SDANN有改善作用,其中对迷走神经与交感神经共同控制的LF/HF可能有改善作用(在患病群体中改善作用明显),而对LF可能没有改善作用,并可改善患者焦虑状况。Objective:To systematically analyze the effect of acupuncture on heart rate variability(HRV).Methods:RCTs of the effect of acupuncture on HRV were reviewed from PubMed,Embase,Cochrane Library,CNKI,VIP,CBM disk and Wanfang Database.The control group adopted conventional standard control.Preliminary data extraction of the literature was conducted by two researchers through reading the title and abstract of the articles combined with the full text.16 pieces of literature were finally included through analysis by re-reading the full text.The improvements of scales of SDNN,SDANN,RMSSD,PNN50,LF,HF,LF/HF,HR,TP and HAMD were analyzed after the intervention ofβ-blocker by using Revman5.3 software.Results:SDNN(SMD:1.22%,CI=[0.31,2.14],Z=2.61 P=0.009);RMSSD(SMD:0.31%,CI=[0.09,0.54],Z=2.71,P=0.007);PNN50(MD:2.45%,CI=[1.89,3.00],Z=8.70,P<0.00001);HF(SMD:0.42%,CI=[0.14,0.70],Z=2.91,P=0.004);LF/HF patients(MD:-0.37%,CI=[-0.70,-0.03],Z=2.16,P=0.03),Heart rate:(MD:-1.78%,CI=[-2.29,-0.65],Z=3.08,P=0.002);of which there were statistical differences between before and after the treatment,which indicated that acupuncture had significant improving effects on them.However,LF(SMD:-0.56%,CI=[-1.18,0.06],Z=1.77,P=0.08);LF/HF in healthy people(MD:-0.51%,CI=[-1.07,0.04],Z=1.80,P=0.07);of which there were no statistical differences between before and after the treatment,so it could not show that acupuncture had effects on them.Conclusion:Acupuncture can improve HRV,it can improve PNN50,RMSSD and HF controlled by vagus nerve,it can also improve SDNN and SDANN controlled by sympathetic nerve;it may improve LF/HF controlled by both vagus nerve and sympathetic nerve(significant improving effect in the diseased population),but it has no improving effect on LF.It can also improve the anxiety of the patients.

关 键 词：针刺 心率变异性 META 随机对照 自主神经 

分 类 号：R246.1[医药卫生—针灸推拿学]