Acupuncture treatment for improving anxiety status in patients with primary insomnia:a systematic review and meta-analysis  

针刺改善原发性失眠患者焦虑状态的系统评价和Meta分析

作　　者：ZHANG Xifen WANG Xuesong CHEN Hao LI Xuxin GAO Yuanbo ZUO Guang ZHANG Juncha LIU Jun FAN Xisheng SHE Yanfen 张细芬;王雪松;陈豪;李旭欣;高渊博;左广;张俊茶;刘君;范玺胜;佘延芬(School of Acupuncture-moxibustion and Tuina,Hebei University of Chinese Medicine,Shijiazhuang 050200,China;Hebei International Joint Research Center for Dominant Diseases in Chinese Medicine and Acupuncture,Shijiazhuang 050200,China)

机构地区：[1]School of Acupuncture-moxibustion and Tuina,Hebei University of Chinese Medicine,Shijiazhuang 050200,China [2]Hebei International Joint Research Center for Dominant Diseases in Chinese Medicine and Acupuncture,Shijiazhuang 050200,China

出　　处：《Journal of Acupuncture and Tuina Science》2024年第5期423-434,共12页针灸推拿医学（英文版）

基　　金：国家重点研发计划,No.2022YFC3500601;河北中医药大学2022年国家级大学生创新训练项目,No.202214432024.

摘　　要：Objective:To evaluate the clinical efficacy of acupuncture in the treatment of anxiety state in patients with primary insomnia(PI).Methods:Randomized controlled trials of acupuncture treatment for PI patients with an anxiety state in Web of Science,Cochrane Library,PubMed,Excerpta Medica Database(EMBASE),China National Knowledge Infrastructure(CNKI),Wanfang Data Knowledge Service Platform(Wanfang),and Chongqing VIP Database(VIP)were retrieved by computer.The retrieval time was from each database’s inception to December 30,2022.Data extraction and evaluation were performed for the included studies.The Cochrane risk of bias assessment tool was used to assess the risk of bias in each article.Meta-analysis of valid data was performed using the RevMan 5.4 software.If the outcome indicator was a categorical variable,relative risk(RR)was used as the effect size.If it was a continuous variable,mean difference(MD)was used to calculate the effect size.Each effect size was expressed as a 95%confidence interval(CI).P<0.05 was considered to indicate a statistically significant difference.Results:A total of 18 studies were included,comprising a total of 1198 patients.The findings of the meta-analysis showed that electroacupuncture had a significant advantage in improving the Hamilton anxiety scale(HAMA)score than benzodiazepines[MD=-1.61,95%CI(-2.17,-1.06),P<0.001].Acupuncture was superior to sham acupuncture[MD=-14.90,95%CI(-20.39,-9.41),P<0.001]and benzodiazepines[MD=-3.39,95%CI(-4.67,-2.12),P<0.001]in reducing the self-rating anxiety scale(SAS)score.Acupuncture was superior to sham acupuncture in reducing the insomnia severity index(ISI)score[MD=-5.61,95%CI(-6.63,-4.89),P<0.001].Acupuncture was superior to benzodiazepines[MD=0.84,95%CI(-1.42,-0.25),P=0.005]and sham acupuncture[MD=-8.39,95%CI(-8.39,-7.86),P<0.001]in improving the Pittsburgh sleep quality index(PSQI)score.Acupuncture had a better effective rate than benzodiazepines[RR=1.16,95%CI(1.08,1.25),P<0.001]and sham acupuncture[RR=8.94,95%CI(4.63,17.25),P<0.001]in tr目的:系统评价针刺治疗原发性失眠(PI)患者焦虑状态的临床疗效。方法:计算机系统检索Web of Science、Cochrane Library、PubMed、EMBASE、中国知网(CNKI)、万方数据知识服务平台(Wanfang)和维普资讯中文期刊服务平台(VIP),检索建库至2022年12月30日公开发表的有关针刺治疗PI患者伴有焦虑状态的随机对照试验。对纳入研究的文献进行数据提取和评估;使用Cochrane偏倚风险评价工具评估每篇文章的偏倚风险;对有效数据采用RevMan5.4软件进行meta分析。结局指标若为分类变量采用相对危险度(RR)作为效应量;若为连续性变量则采用均数差(MD)作为效应量。各效应量均以95%可信区间(CI)表示。P<0.05表示差异有统计学意义。结果:共纳入18篇文献,包含1198例患者。Meta分析结果表明电针在改善汉密尔顿焦虑量表(HAMA)评分方面明显优于苯二氮卓类西药[MD=-1.61,95%CI(-2.17,-1.06),P<0.001];针刺在降低焦虑自评量表(SAS)评分方面优于假针刺[MD=-14.90,95%CI(-20.39,-9.41),P<0.001]和苯二氮卓类西药[MD=-3.39,95%CI(-4.67,-2.12),P<0.001];针刺在降低失眠严重程度指数(ISI)评分方面优于假针刺[MD=-5.61,95%CI(-6.33,-4.89),P<0.001];针刺在改善匹兹堡睡眠质量指数(PSQI)评分方面优于苯二氮卓类西药[MD=0.84,95%CI(-1.42,-0.25),P=0.005]和假针刺[MD=-8.39,95%CI(-8.93,-7.86),P<0.001];在治疗PI的有效率方面,针刺优于苯二氮卓类西药[RR=1.16,95%CI(1.08,1.25),P<0.001]和假针刺[RR=8.94,95%CI(4.63,17.25),P<0.001]。结论:针刺或电针治疗PI患者焦虑状态较苯二氮卓类西药和假针刺治疗有一定的疗效优势,但尚需更多高质量的随机对照试验进一步验证。

关 键 词：Acupuncture Therapy ELECTROACUPUNCTURE INSOMNIA ANXIETY Meta Analysis Systematic Review 

分 类 号：R246.6[医药卫生—针灸推拿学]