针灸治疗甲状腺癌术后焦虑抑郁状态的Meta分析

Meta-Analysis of Acupuncture Treatment for Anxiety and Depression Status in Postoperative Thyroid Cancer Patients

摘要: 目的：研究针灸治疗甲状腺癌患者术后焦虑抑郁状态的临床效果。方法：检索中英文医学数据库中有关针灸改善甲状腺癌患者术后负性情绪的随机对照试验(RCT)。中文文献检索覆盖中国知网(CNKI)、万方数据库(Wanfang)、维普资讯中文期刊服务平台(VIP)及中国生物医学文献数据库(SinoMed)；英文文献检索则依托Web of Science、PubMed、EMBASE、Cochrane Library进行。检索时间跨度为各数据库建库起至2025年12月31日。由研究人员独立完成文献检索，并严格按照纳入、排除标准进行初筛与复筛，随后对最终纳入的文献进行分类整理，完成基本资料与数据的提取及偏倚风险评估后，使用RevMan 5.4进行Meta分析。结果：最终共纳入7篇文献，总计881例患者。其中，干预组441例，对照组440例。结果显示：以针灸为核心的干预方案显著降低了患者术后焦虑状态评分(SMD = −1.33, 95% CI = [−1.5, −1.17], P < 0.00001)、抑郁状态评分(SMD = −1.99, 95% CI = [−2.80, −1.18], P < 0.00001)以及睡眠质量评分(MD = −3.24, 95% CI = [−3.40, −3.07], P < 0.00001)；对焦虑、抑郁结局剔除联合干预后行单纯针灸干预的敏感性分析，证实单纯针灸疗效高度一致且异质性显著降低，睡眠质量结局因仅包含2篇单纯针灸干预研究纳入故未行敏感性分析；此外，按年龄进行的亚组分析为探索性结果，各亚组样本量有限，统计稳定性不足。结论：以针灸治疗为核心的综合干预方案在促进甲状腺癌患者术后康复，特别是改善焦虑抑郁状态及睡眠质量方面具有积极作用，其中单纯针灸干预对焦虑、抑郁的改善效应一致性高，不同年龄组的疗效差异为探索性结果。本研究证据质量中等，其确切疗效仍需更多严格遵循方法学规范的高质量研究以进一步验证。

Abstract: Objective: To investigate the clinical efficacy of acupuncture in improving anxiety and depression in postoperative thyroid cancer patients. Methods: Randomized controlled trials (RCTs) on acupuncture for improving negative emotions after thyroid cancer surgery were retrieved from Chinese and English medical databases. Chinese literature searches covered China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Chinese Journal Service Platform, and Chinese Biomedical Literature Database (SinoMed). English literature searches were conducted via Web of Science, PubMed, EMBASE, and Cochrane Library. The retrieval period was from database inception to December 31, 2025. Literature searches were independently conducted by researchers, and initial and secondary screenings were strictly performed according to inclusion and exclusion criteria. After classification, data extraction, and risk of bias assessment of the included studies, a Meta-analysis was conducted using RevMan 5.4 software. Results: A total of seven studies involving 881 patients were included, with 441 patients in the intervention group and 440 patients in the control group. The results showed that acupuncture-based intervention significantly reduced postoperative anxiety scores (SMD = −1.33, 95% CI = [−1.5, −1.17], P < 0.00001), depression scores (SMD = −1.99, 95% CI = [−2.80, −1.18], P< 0.00001), and sleep quality scores (MD = −3.24, 95% CI = [−3.40, −3.07], P < 0.00001). Sensitivity analysis of pure acupuncture after excluding combined interventions for anxiety and depression outcomes confirmed that the efficacy of pure acupuncture was highly consistent with significantly reduced heterogeneity, and sensitivity analysis was not performed for sleep quality due to only 2 pure acupuncture studies being included. Subgroup analysis by age was an exploratory result with a limited sample size and insufficient statistical stability in each subgroup. Conclusion: Acupuncture-based comprehensive intervention has a positive effect in promoting postoperative recovery, improving anxiety, depression, and sleep quality in thyroid cancer patients, among which pure acupuncture has a high consistency in improving anxiety and depression, and the difference in efficacy among different age groups is an exploratory result. The quality of evidence in this study is moderately low, and its exact efficacy needs to be further verified by more high-quality studies that strictly follow methodological norms.