针刺对围绝经期失眠患者睡眠质量及性激素水平调节作用Meta分析

来源:用户上传      作者:刘俊 张涛 胡俊霞 郭静

　　摘要 目的：u价针刺对围绝经期失眠患者睡眠质量及血清性激素的干预作用。方法：通过计算机检索PubMed、Web of Science、国家知识基础设施数据库（CNKI）、中国学术期刊数据库（CSPD）和中文科技期刊数据库（CCD），检索关于针刺治疗围绝经期失眠的随机对照试验（RCT），由2名研究员独立进行文献筛选、资料提取及偏倚风险评价，最后应用RevMan5.4软件进行Meta分析。结果：最终纳入文献14篇，涉及1 428例围绝经期失眠患者。Meta分析结果显示：采用随机效应模型，针刺组与对照组治疗后匹兹堡睡眠质量指数（PSQI）评分差异有统计学意义（MD=-2.57，95%CI为-4.29～-0.86，P=0.003，促卵泡激素（FSH）、雌二醇差异无统计学意义（MD=-5.41，95%CI为-12.00～1.17，P=0.11;MD=6.95，95%CI为-1.62～15.51，P=0.11）。亚组分析结果显示：针刺组与中药组、西药组对照，治疗后PSQI评分无显著差异，针刺组与假针组、健康宣教对照组，治疗后PSQI评分差异有统计学意义。结论：针刺可以改善围绝经期失眠患者睡眠质量，其效果与中药、西药相似，明显优于健康宣教、假针，但对血清性激素水平影响不显著。因受文献数量及质量的限制，未来仍需增加高质量的RCT，扩大样本量予以验证，其机制仍有待深入探讨。
　　关键词 针刺;围绝经期;失眠;睡眠质量;匹兹堡睡眠质量指数;性激素;Meta分析;系统评价
　　Regulatory Effects of Acupuncture Therapy on Sleep Quality and Sex Hormone Levels in Patients with Perimenopausal Insomnia：A Meta-analysis
　　LIU Jun1，ZHANG Tao2，HU Junxia2，GUO Jing2
　　（1 Graduate School，Beijing University of Chinese Medicine，Beijing 100029，China;2 Acupuncture and Moxibustion Department/Beijing Key Laboratory of Nerve Regulation of Acupuncture and Moxibustion，Beijing Hospital of Traditional Chinese Medicine，Capital Medical University，Beijing 100010，China）
　　Abstract Objective：To evaluate the regulatory effects of acupuncture on sleep quality and serum sex hormone levels in patients with perimenopausal insomnia（PMI）.Methods：PubMed，Web of Science，CNKI，CSPD，and CCD were searched for randomized controlled trials（RCTs） of acupuncture in the treatment of PMI.Two investigators independently performed literature screening，data extraction，and risk of bias assessment.Finally，RevMan 5.4 was used for Meta-analysis.Results：Fourteen research articles involving 1 428 patients with PMI were eligible for the study.As revealed by the results of the Meta-analysis，the random effects model was adopted.The Pittsburgh Sleep Quality Index（PSQI） score was statistically different between the acupuncture group and the control group（MD=-2.57，95%CI -4.29 to -0.86，P=0.003），but there was no significant difference in follicle-stimulating hormone（FSH） and estradiol（E2）（MD=-5.41，95%CI -12.00 to 1.17，P=0.11; MD=6.95，95%CI -1.62 to 15.51，P=0.11）.The results of the subgroup analysis showed that there was no significant difference in PSQI score between the acupuncture group and the Chinese medicine group and the western medicine group after treatment.There were statistically significant differences in PSQI score between the acupuncture group and the sham acupuncture group and the health education control group after treatment.Conclusion：Acupuncture can improve the sleep quality of patients with perimenopausal insomnia，with a similar effect to Chinese medicine and western medicine，and it is superior to health education and sham acupuncture，but the effect on serum sex hormone levels was not significant.Due to the limitation of the number and quality of research articles，the above conclusion needs to be verified by high-quality RCTs with a large sample size in the future.The mechanism remains to be further explored.

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