正念减压疗法在乳腺癌患者应用效果的系统评价再评价

• 作者： 郑卿勇, 赵亮, 隗伟, 任雪君, 王超, 孙瑞, 丛明华, 于雷, 杨敏 ¹
• 作者单位：
  1.  兰州大学护理学院,兰州大学循证护理中心,甘肃兰州,730000国家癌症中心／国家肿瘤临床医学研究中心／中国医学科学院北京协和医学院肿瘤医院综合科,北京,100021中国医学科学院肿瘤医院
• 提交时间：2022-09-13

摘要: 背景　乳腺癌已成为全球第一大癌种，其治疗与康复过程往往给患者带来严重的心理困扰。诸多系统评价（SR）发现正念减压疗法（MBSR）在乳腺癌患者心理照护方面有一定效果，但不同SR纳入的原始研究质量、证据等级以及观察指标等存在较大区别，以致结局指标差异显著。目的　对MBSR在乳腺癌患者应用效果的SR进行再评价，从而为乳腺癌患者的心理照护提供决策参考。方法　系统检索PubMed、Embase、the Cochrane Library、Web of Science、CINAHL、PsycINFO、JBI，中国知网、万方医学数据库及中国生物医学文献数据库关于MBSR在乳腺癌患者干预的SR，检索时间截至2022年7月。两位研究者对文献进行筛选后提取研究相关信息，分别应用系统评价方法学质量评价工具-2（AMSTAR 2）、系统综述和荟萃分析优先报告的条目（PRISMA）及证据质量与推荐强度分级（GRADE）进行方法学质量、报告规范及证据质量评估。结果　共计14篇SR纳入再评价分析。AMSTAR 2显示整体方法学质量不高，仅有1篇为高质量研究，2项关键条目信息严重缺失。PRISMA声明显示报告质量缺陷主要在研究方案注册、研究间偏倚风险评估及资金来源方面。14篇SR共包括15项结局指标及73个证据体，GRADE显示2个为高质量，48个为中等质量，23个为低质量。MBSR能够不同程度地改善乳腺癌患者焦虑、抑郁、疲乏、及压力等，且短期疗效显著，但长期疗效尚不确定。结论　目前关于MBSR在乳腺癌患者应用效果的SR证据质量整体水平不高，研究的方法学质量及报告规范程度均有待进一步提高，MBSR对于乳腺癌患者心理状况等指标改善能力尚佳，但仍需要更多高质量、大样本的研究以进一步验证。

Abstract: Background　Breast cancer has become the most prevalent cancer worldwide and its treatment, and recovery process often causes severe psychological distress to patients. Numerous systematic reviews (SRs) have found Mindfulness-based stress reduction (MBSR) to be effective in the psychological care of breast cancer patients. However, the quality of the original studies included in the SR, the level of evidence, and the observed indicators vary considerably, resulting in significant differences in outcome indicators. Objective　To re-evaluate the SRs on the efficacy of MBSR in breast cancer patients and to provide decision-making references for the application of MBSR in the psychological care of breast cancer patients. Methods PubMed, Embase, The Cochrane Library, Web of Science, CINAHL, PsycINFO, JBI, China National Knowledge Infrastructure (CNKI), WanFang Data and China BioMedical Literature database (CBM) were systematically searched for SR/Meta-analysis of MBSR in breast cancer patients, searched up to July 2022. Two investigators screened the literature based on inclusion and exclusion criteria and extracted relevant information. The methodological quality, reporting norms and quality of evidence were assessed through A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Grading of Recommendations, Assessment, Development and Evaluations (GRADE), respectively. Results　A total of 14 SR were identified. AMSTAR 2 showed that only 1 SR was a high-quality study, and two essential items were missing. PRISMA statement showed that the reporting quality deficiencies were mainly in the study protocol registration, risk of inter-study bias assessment and funding sources. There were 15 outcome indicators with 73 bodies of evidence in 14 SR, and the GRADE showed that 2 were of high quality, 48 were of moderate quality, and 22 were of low quality. MBSR could improve breast cancer patients’ anxiety, depression, fatigue and stress in different degrees, and the short-term effect was significant, but the long-term effect was uncertain. Conclusion　The quality of evidence for SR for MBSR interventions in breast cancer patients is not yet high, and the methodological quality and reporting standard of the studies need to be further improved. MBSR has shown promising improvements in psychological status and other indicators in breast cancer patients, but more high-quality, large sample studies are needed to validate further.

• 分类： 医学、药学 >> 基础医学
• 引用： ChinaXiv:202209.00115 (或此版本 ChinaXiv:202209.00115V1)
  DOI:10.12114/j.issn.1007-9572.2022.0649
  CSTR:32003.36.ChinaXiv.202209.00115.V1
• 推荐引用方式： 郑卿勇, 赵亮, 隗伟, 任雪君, 王超, 孙瑞, 丛明华, 于雷, 杨敏.(2022).正念减压疗法在乳腺癌患者应用效果的系统评价再评价.中国全科医学.doi:10.12114/j.issn.1007-9572.2022.0649 (点此复制)