Meta-analysis on effectiveness of cognitive-behavioral therapy for irritable bowel syndrome in China

doi:10.3877/cma.j.issn.2095-2015.2017.02.005

Abstract

Abstract:

Objective

To evaluate the effectiveness of cognitive-behavioral therapy(CBT)for the treatment of irritable bowel syndrome(IBS)patients in China.

Methods

Publications on the randomized controlled trials(RCTs)of CBT for the treatment of IBS patients in China from the databases including PubMed, Cochrane Library, EMBase, CNKI, CBM and WanFang data were searched up to April 30, 2016.The selected articles were evaluated for the methodological qualities and the related data were extracted for further Meta-analysis by Review Manager 5.3.

Results

A total of 9 RCTs involving 907 patients were included.Results of Meta-analysis showed that compared with the monotherapy of usual drugs, the combination of CBT and usual drugs was statistically better in the improvements of overall symptom effective rates of IBS(RR=1.16, P=0.000 2), anxiety/depression scores(SMD=-0.96, P=0.004; SMD=-0.86, P=0.03)and the overall quality of life such as social functions, interpersonal relationships, health worry and interference with activity(P<0.05)in Chinese population.But the monotherapy of CBT was not superior to usual drugs in the improvement of overall symptom effective rates(RR=0.91, P=0.15).

Conclusion

The combination of CBT and usual therapy can significantly improve the overall symptoms, psychological states and life quality of IBS patients in China.The monotherapy of CBT is not significantly superior to usual therapy in the improvement of IBS symptoms.

Key words: Irritable bowel syndrome, Cognitive therapy, Meta-analysis

Jing Yang, Xiaofei Lei, Kun Li, Shuangling Li, Changqing Xu, Hongli Yang. Meta-analysis on effectiveness of cognitive-behavioral therapy for irritable bowel syndrome in China[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2017, 07(02): 66-74.

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Figures/Tables 8

References 20

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纳入研究	样本(T/C)	平均年龄(T/C)	女性[例(%)，T/C]	诊断标准	临床分型	干预措施			结局指标
纳入研究	样本(T/C)	平均年龄(T/C)	女性[例(%)，T/C]	诊断标准	临床分型	对照组	试验组	持续时间	结局指标
董文珠，2011	31/31	36.61±10.37/35.90±10.51	17(54.8)/17(54.8)	罗马Ⅲ	IBS-D	常规药物	常规药物＋CBT	8周	IBS症状总有效率和显效率；SF-36生活质量评分
贾悦，2015	35/35	44.74±11.98/40.85±13.87	不详	罗马Ⅲ	IBS-D	常规药物	常规药物＋CBT	8周	Zung焦虑抑郁评分；IBS-QOL
崔爱群，2014	30/30	36±10	36(60)	罗马Ⅲ	不详	常规治疗	常规治疗＋CBT	4周	IBS症状总有效率；Zung焦虑抑郁评分；1年后随访复发率
池丹妮，2009	30/30/30/30	38.74±12.31	不详	罗马Ⅲ	IBS-D	等待治疗	米氮平、CBT、米氮平＋CBT	8周	IBS症状总有效率；HAMD/HAMA；ATQ/DAS/CSQ；IBS-QOL
李洪芬，2011	69/70/78/79	44.29±11.23	51(73.9)/46(65.7)/52(66.7)/48(60.8)	罗马Ⅱ	不详	无干预措施	常规药物、CBT、常规药物＋CBT	12周	IBS症状总有效率；IBS-SSS；HAMD/ HAMA；IBS-QOL
蒋宗路，2011	29/12	45/43	18(62.0)/7(58.3)	罗马Ⅲ	IBS-D/C/M	常规药物	常规药物＋CBT	3-6月	IBS症状总有效率
黄汝金，2011	30/30/30	不详	不详	罗马Ⅲ	不详	常规药物	CBT、常规药物＋CBT	12周	IBS症状总有效率；单项症状积分；HAMD显效率无
柴玉萍，2014	54/54	37.41±8.02/37.33 ±7.99	36(63.0)/35(64.8)	罗马Ⅲ	IBS-D	常规药物＋氟哌噻吨美利曲辛	常规药物＋氟哌噻吨美利曲辛＋CBT	8周	IBS症状总有效率和单项症状有效率；SCL-90心理评分
朱爱芳，2003	30/30	38.7±12.6	40(66.7)	罗马Ⅱ	IBS-D/C	常规药物	常规药物＋CBT	12周	IBS症状总有效率；SCL-90心理评分；直肠测压疼痛阈值

纳入研究	样本(T/C)	平均年龄(T/C)	女性[例(%)，T/C]	诊断标准	临床分型	干预措施			结局指标
纳入研究	样本(T/C)	平均年龄(T/C)	女性[例(%)，T/C]	诊断标准	临床分型	对照组	试验组	持续时间	结局指标
董文珠，2011	31/31	36.61±10.37/35.90±10.51	17(54.8)/17(54.8)	罗马Ⅲ	IBS-D	常规药物	常规药物＋CBT	8周	IBS症状总有效率和显效率；SF-36生活质量评分
贾悦，2015	35/35	44.74±11.98/40.85±13.87	不详	罗马Ⅲ	IBS-D	常规药物	常规药物＋CBT	8周	Zung焦虑抑郁评分；IBS-QOL
崔爱群，2014	30/30	36±10	36(60)	罗马Ⅲ	不详	常规治疗	常规治疗＋CBT	4周	IBS症状总有效率；Zung焦虑抑郁评分；1年后随访复发率
池丹妮，2009	30/30/30/30	38.74±12.31	不详	罗马Ⅲ	IBS-D	等待治疗	米氮平、CBT、米氮平＋CBT	8周	IBS症状总有效率；HAMD/HAMA；ATQ/DAS/CSQ；IBS-QOL
李洪芬，2011	69/70/78/79	44.29±11.23	51(73.9)/46(65.7)/52(66.7)/48(60.8)	罗马Ⅱ	不详	无干预措施	常规药物、CBT、常规药物＋CBT	12周	IBS症状总有效率；IBS-SSS；HAMD/ HAMA；IBS-QOL
蒋宗路，2011	29/12	45/43	18(62.0)/7(58.3)	罗马Ⅲ	IBS-D/C/M	常规药物	常规药物＋CBT	3-6月	IBS症状总有效率
黄汝金，2011	30/30/30	不详	不详	罗马Ⅲ	不详	常规药物	CBT、常规药物＋CBT	12周	IBS症状总有效率；单项症状积分；HAMD显效率无
柴玉萍，2014	54/54	37.41±8.02/37.33 ±7.99	36(63.0)/35(64.8)	罗马Ⅲ	IBS-D	常规药物＋氟哌噻吨美利曲辛	常规药物＋氟哌噻吨美利曲辛＋CBT	8周	IBS症状总有效率和单项症状有效率；SCL-90心理评分
朱爱芳，2003	30/30	38.7±12.6	40(66.7)	罗马Ⅱ	IBS-D/C	常规药物	常规药物＋CBT	12周	IBS症状总有效率；SCL-90心理评分；直肠测压疼痛阈值

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