目的 基于脑功能磁共振成像(Functional magnetic resonance imaging,fMRI),采用Meta分析系统评价针灸治疗抑郁症(Major depressive disorder,MDD)的有效性.方法 检索 CNKI、CBM、Wan fang、VIP、PubMed、Web of Science、Embase、Cochrane Library从建库以来至2023年10月31日针灸治疗MDD的随机对照研究(RCT),纳入研究质量评估采用Cochrane偏倚风险评估工具,利用RevMan 5.3软件行Meta分析,并采用Cochrane工具自带的GRADE系统进行证据质量评价.结果 纳入文章9篇,包括7篇国内文章,2篇国外文章,总样本量636例(试验组325例,对照组311例).9项研究均以fMRI为主要观察指标,结果显示针灸可调节差异脑区低频振幅(Amplitude of low frequency fluctuation,ALFF)、低频振幅比率(Fractional of amplitude low-frequency fluctuation,f ALFF)及局部一致性(Region homogeneity,ReHo)值,改变脑功能连接.次要结局指标分析结果显示针灸治疗可明显改善MDD患者的症状,提高临床疗效[OR=1.98,95%CI(1.30,2.99),P=0.001],减轻抗抑郁药物带来的副反应,并有效降低患者的汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分[MD=-3.08,95%CI(-4.46,-1.70),P<0.0001]、Zung 抑郁自评量表(Self-rating depression scale,SDS)评分[MD=-4.67,95%CI(-6.93,-2.40),P<0.0001]、抗抑郁药副反应量表(Side-effect rating scale for antidepressant,SERS)总分,降低血浆促肾上腺皮质激素[MD=-3.22,95%CI(-5.00,-1.43),P=0.0004]水平及血清皮质醇激素水平.结论 针灸治疗MDD效果显著,可激活边缘系统脑区,重组MDD发病的认知、情感加工及默认网络结构,并对额叶进行调节,从而改善抑郁.
Systematic Evaluation of Clinical Efficacy of Acupuncture and Moxibustion in the Treatment of Depression Based on Brain Functional Magnetic Resonance Imaging
Objective To systematically evaluate the effectiveness of acupuncture and moxibustion in treating ma-jor depressive disorder(MDD)based on functional magnetic resonance imaging(fMRI)using a Meta-analysis approach.Methods Randomized controlled trials(RCTs)on acupuncture and moxibustion treatment for MDD were retrieved from CNKI,CBM,Wanfang Data,VIP,PubMed,Web of Science,Embase,and the Cochrane Library from their inception to Octo-ber 31,2023.The Cochrane risk of bias tool was used to assess the quality of the included studies.Meta-analysis was per-formed using RevMan 5.3 software,and the quality of evidence was evaluated using the GRADE system provided by the Cochrane tool.Results A total of 9 studies were included,comprising 7 Chinese studies and 2 international studies,with a total sample size of 636 cases(325 in the experimental group and 311 in the control group).All 9 studies used fMRI as the primary outcome measure.The results indicated that acupuncture and moxibustion could regulate the amplitude of low-fre-quency fluctuation(ALFF),the fractional amplitude of low-frequency fluctuation(fALFF),and the regional homogeneity(ReHo)values of different brain areas,thus altering brain functional connectivity.Secondary outcome measures showed that acupuncture and moxibustion significantly improved the symptoms of MDD patients,enhanced clinical efficacy(OR=1.98,95%CI[1.30,2.99],P=0.001),reduced the side effects of antidepressants,and effectively lowered patients'Hamilton Depression Rating Scale(HAMD)scores(MD=-3.08,95%CI[-4.46,-1.70],P<0.000 1),Self-rating Depres-sion Scale(SDS)scores(MD=-4.67,95%CI[-6.93,-2.40],P<0.000 1),and the total scores on the Side-Effect Rating Scale for Antidepressants(SERS).It also reduced plasma adrenocorticotropic hormone(MD=-3.22,95%CI[-5.00,-1.43],P=0.000 4)and serum cortisol levels.Conclusion Acupuncture and moxibustion therapy is highly effective in treating MDD,which can activate brain regions within the limbic system,reorganize the cognitive,emotional processing,and default mode network structures related to MDD,and regulate the frontal lobe,thereby alleviating depres-sion.
DepressionAcupuncture and MoxibustionBrain Functional Magnetic Resonance ImagingRandom-ized Controlled TrialMeta-analysis