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首页> 中文期刊> 《中华精神科杂志》 >光照疗法对非季节性抑郁症疗效的随机对照试验系统评价和Meta分析

光照疗法对非季节性抑郁症疗效的随机对照试验系统评价和Meta分析

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摘要

Objective To explore the efficacy of light therapy (LT) for nonseasonal major depressive disorder with systematic review and meta-analysis. Methods Literature were systematically searched from the Pubmed, Embase, Web of science, cochrane library, China national knowledge infrastructure (CNKI), Wanfang data (Wanfang), China biology medicine disc (CBMdisc) till 28/02/2016 with keywords"depress*""mood" "affective" "light therapy" "light-therapy" "light treatment" and "phototherapy". Papers were also searched from the references of relevant published systematic reviews and meta-analyses. Studies were selected by screening with predefined inclusion and exclusion criteria. Change from baseline of depression rating scales was chosen as primary outcome, and response rate and remission rate were chosen as secondary outcomes. The strength of evidence was graded according to the criteria of grading of recommendations assessment development and evaluation (GRADE). Meta-analysis and subgroup analysis were performed in Revman 5.3. Results Twelve studies with 332 patients in LT group and 325 patients in control group were finally included in the meta-analysis. The heterogeneity between the included studies was relatively large. LT was superior to control in change from baseline scores of depression rating scales (SMD:0.58, 95%CI 0.35-0.81, P<0.01), while no significant difference between the two groups was detected in the subgroup analysis of perinatal depression and peri-menopausal depression (SMD:0.59, 95%CI-0.18-1.36,P=0.130). LT group achieved high response rate than control group in the overall meta-analysis (OR=2.51, 95%CI 1.65-3.81,P<0.01) and subgroup analyses (LT combination with antidepressants, OR=2.62, 95%CI 1.23-5.57,P=0.01,I2=50%;LT alone, OR=2.37,95%CI 1.11-5.07,P=0.03,I2=0%). Nevertheless, no significant difference was found between LT and control in the subgroup analyses of remission rate (LT combination with antidepressants, OR=2.46, 95%CI 0.64-9.39 ,P=0.19; LT alone, OR=2.49, 95%CI 0.91-6.82, P=0.08). GRADE assessment of the evidence indicated that the evidence was moderate for response rate, and low for change from baseline scores of depression scales and remission rate. Conclusions LT is effective for nonseasonal major depressive disorder as a whole, the null results of some subgroup analyses may be due to the small sample size of these subgroups and insensitivity of remission rate in detecting difference between groups.%目的 对光照疗法治疗非季节性抑郁症疗效的RCT试验进行系统评价和Meta分析,为光照疗法对非季节性抑郁症的疗效提供循证医学依据.方法 系统检索Pubmed、Embase、Web of science、Cochrane图书馆(Cochrane library)及中国期刊全文数据库(China national knowledge infrastructure,CNKI)、万方数据库和中国生物医学文献数据库(China biology medicine disc,CBMdisc),检索时间截至2016年2月28日,检索关键词包括"depress*""mood""affecitve""light therapy""light-therapy""phototherapy""light treatment""抑郁症"和"光照".手工检索关于光照疗法对抑郁症疗效相关Meta分析的参考文献.根据纳入标准及排除标准筛选文献.选取治疗前后抑郁评定量表减分值为主要疗效指标,以有效率、临床治愈率为次要疗效指标.根据GRADE(Grading of Recommendations Assessment,Development and Evaluation)方法对上述指标进行证据强度评级,应用Revman 5.3软件进行Meta分析和亚组分析.结果 最终纳入12篇文献,光照组332例,对照组325例.光照组治疗前后抑郁评定量表减分值显著高于对照组(SMD:0.58,95%CI 0.35~0.81,P<0.01),但在围产期和围绝经期抑郁症患者的亚组分析中,2组疗效差异无统计学意义(SMD:0.59,95%CI-0.18~1.36,P=0.130).有效率的Meta分析及亚组分析中,光照组优于对照组(OR=2.51,95%CI 1.65~3.81,P<0.01;联合药物治疗:OR=2.62,95%CI 1.23~5.57,P=0.01,I2=50%;单独光照治疗:OR=2.37,95%CI 1.11~5.07,P=0.03,I2=0%);临床治愈率的亚组分析中,光照组与对照组差异无统计学意义(联合药物治疗:OR=2.46,95%CI 0.64~9.39,P=0.19;单独光照治疗:OR=2.49,95%CI 0.91~6.82,P=0.08).证据强度评级显示,有效率的证据强度为中等,临床治愈率和治疗前后抑郁严重程度变化的证据强度为低.结论 光照疗法总体上对非季节性抑郁症有效,亚组分析中的阴性结果可能与亚组样本量较小以及指标欠敏感有关.

著录项

  • 来源
    《中华精神科杂志》 |2017年第3期|214-221|共8页
  • 作者

    刘帮杉; 张丽; 汪露; 陈彦超; 王汨; 张燕; 李凌江;

  • 作者单位

    410011长沙,中南大学湘雅二医院精神卫生研究所国家精神心理疾病临床研究中心精神疾病诊疗技术工程实验室湖南省精神病学与精神卫生重点实验室;

    410011长沙,中南大学湘雅二医院精神卫生研究所国家精神心理疾病临床研究中心精神疾病诊疗技术工程实验室湖南省精神病学与精神卫生重点实验室;

    410011长沙,中南大学湘雅二医院精神卫生研究所国家精神心理疾病临床研究中心精神疾病诊疗技术工程实验室湖南省精神病学与精神卫生重点实验室;

    410011长沙,中南大学湘雅二医院精神卫生研究所国家精神心理疾病临床研究中心精神疾病诊疗技术工程实验室湖南省精神病学与精神卫生重点实验室;

    410011长沙,中南大学湘雅二医院精神卫生研究所国家精神心理疾病临床研究中心精神疾病诊疗技术工程实验室湖南省精神病学与精神卫生重点实验室;

    410011长沙,中南大学湘雅二医院精神卫生研究所国家精神心理疾病临床研究中心精神疾病诊疗技术工程实验室湖南省精神病学与精神卫生重点实验室;

    410011长沙,中南大学湘雅二医院精神卫生研究所国家精神心理疾病临床研究中心精神疾病诊疗技术工程实验室湖南省精神病学与精神卫生重点实验室;

  • 原文格式 PDF
  • 正文语种 chi
  • 中图分类
  • 关键词

    抑郁症; 系统分析; 光照治疗;

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