4种不同机制的临床常用抗抑郁药治疗中国抑郁症患者有效率的单组率Meta分析

Clinical Effective Rate of Four Clinical Commonly Used Antidepressants with Different Therapeutic Mechanisms in Depression Disorder in China: A Meta-analysis of Single Rate

关键词:  抑郁症  单组率meta分析  抗抑郁药  临床有效率

Key words:  depression disorder  meta-analysis of single rate  antidepressants  clinical effective rate

摘要:

目的 利用单组率meta分析比较阿米替林、艾司西酞普兰、米氮平和文拉法辛4种不同机制的临床常用抗抑郁药急性期治疗中国抑郁症患者的临床有效率。方法 分别检索维普期刊资源整合服务平台、中国知网和万方数据知识服务平台(万方数据库)获取4种抗抑郁药治疗抑郁症的随机对照试验(RCTs)，检索时限均从建库至2015年7月。由2位研究者按照纳入与排除标准独立进行文献筛选、资料提取和质量评价后，采用单组率meta分析方法对纳入的RCTs进行合并，利用R软件进行统计分析，系统评价上述4种药物的有效率指标。结果 共纳入129篇文献，9 371例抑郁症患者。单组率meta分析的结果显示，临床有效率由高到低依次为艾司西酞普兰76.79%[95%CI(74.18%，79.21%)]、米氮平75.65%[95%CI(73.30%，77.86%)]、文拉法辛75.14%[95%CI(73.03%，77.14%)]、阿米替林70.53%[95%CI(67.73%，73.13%)]。结论 艾司西酞普兰治疗抑郁症的临床有效率最高，但在95%置信区间与米氮平和文拉法辛没有显著性差异，阿米替林临床有效率显著低于前3种药物，从临床有效率角度出发，不推荐使用阿米替林。

Abstract:

OBJECTIVE To systematically review the clinical effective rate of four different therapeutic mechanisms antidepressants of amitriptyline, escitalopram, mirtazapine and venlafaxine in treating acute phase depression disorder in China. METHODS The relative randomized controlled trials(RCTs) about the four antidepressants in the treatment of depression disorder was searched in VIP, CNKI and WanFang Data from the date of their establishment to July 2015. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data and conducted methodological quality evaluation. Meta-analysis of single rate was then performed using R software. RESULTS A total of 129 studies involving 9 371 patients were included. The results of meta-analysis of single rate showed the clinical effective rate of escitalopram, mirtazapine, venlafaxine and amitriptyline were 76.79% [95%CI(74.18%, 79.21%)], 75.65% [95%CI(73.30%, 77.86%)], 75.14% [95%CI(73.03%, 77.14%)] and 70.53% [95%CI(67.73%, 73.13%)], respectively. CONCLUSION Escitalopram’s clinical effective rate is the highest, but no significant differences with mirtazapine and venlafaxine in 95% confidence interval. Amitriptyline’s effective rate is significantly lower than the other three drugs. From the perspective of clinical effective, amitriptyline don’t recommend to be used. Due to the limited quantity and quality of included studies, more high quality studies are needed to verify the above conclusion.