心理干预配合常规药物治疗老年糖尿病的系统评价∗

摘要

目的：系统评价心理干预配合常规药物治疗老年糖尿病的有效性。方法计算机检索 Google Scholar、PubMed、外文医学信息检索平台、EBSCO、SinoMed、CNKI、VIP 和 WangFang Data 数据库,查找有关心理干预配合常规药物治疗老年糖尿病的临床对照试验,检索时限均为2000年1月至2016年1月。试验组采用心理干预联合药物治疗,对照组采用单纯的常规药物治疗。按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,通过 RevMan 5.3软件进行 Meta 分析。结果共纳入22个研究,包括2740例患者。Meta分析结果显示：与对照组相比,试验组老年糖尿病患者在空腹血糖[MD =-1.75,95% CI(-2.14~-1.37),P <0.01]、餐后2 h 血糖[MD =-1.33,95% CI (-1.73~-0.93),P <0.01]、SDS 评分[MD =10.69,95% CI (-14.36~-7.01),P <0.01]、SAS 评分[MD =-3.40,95% CI(-6.30~-0.50),P <0.01]和 HAMA 评分[MD =-4.01,95% CI(-5.04~-2.37),P <0.01]方面具有一定优势,两组比较差异均有统计学意义。结论本研究数据显示,心理干预配合药物治疗老年糖尿病具有一定的优势。但受纳入研究的质量限制,上述结论仍需大样本和质量更高的研究进一步验证。%Objective To systematically review the efficacy of psychological intervention with drugs for diabetes mellitus in the elderly.Methods The clinical controlled trials concerning the efficacy of psychological intervention with drugs for diabetes mellitus between January 2000 and January 201 6 were searched in the databases including Google Scholar,PubMed,The Cochrane Library,CBM,EBSCO,SinoMed,CNKI,VIP and WangFang Data. According to the inclusion and exclusion criteria,two reviewers screened the literature,extracted data,and assessed the methodological quality of the included studies.Then a meta-analysis was conducted with the help of RevMan 5.3 software.Results 22 studies involving 2,740 patients were included.The results of meta-analysis showed that the experiment group was superior to the control group in total effectiveness and there is a significant difference between the two groups in FBG[MD = - 1.75,95% CI (- 2.14 ~ - 1.37 ),P < 0.01 ],PBG [MD = - 1.33,95% CI (-1.73~-0.93),P <0.01],SDS [MD =10.69,95% CI (-14.36~-7.01),P <0.01],SAS [MD =-3.40, 95% CI (-6.30~ - 0.50),P < 0.01 ],and HAMA[MD = - 4.01,95% CI (- 5.04 ~ - 2.37 ),P < 0.01 ]. Conclusion The current evidence indicated that psychological intervention with drugs appears to be more effective for the elderly patients with diabetes.Due to the quality of the included studies,the conclusion needs more verification with larger samples and better studies.