艾司西酞普兰与度洛西汀治疗抑郁症有效性与安全性的Meta分析

摘要

目的:系统评价艾司西酞普兰与度洛西汀治疗抑郁症的有效性和安全性,为临床治疗提供循证参考.方法:计算机检索PubMed、万方数据库、中文科技数据库、中国期刊全文数据库、中国生物医学文献数据库,收集艾司西酞普兰(试验组)与度洛西汀(对照组)治疗抑郁症的临床随机对照试验(RCT),提取数据并按照Cochrane系统评价员手册5.3推荐的偏倚风险评估工具评价文献质量后,采用Rev Man 5.3软件对数据进行Meta分析.结果:共纳入25项RCT,合计2621例患者.Meta分析结果显示,两组患者治疗第1、2、4、6、8周的总有效率及治疗第4、6、8周的治愈率比较,差异均无统计学意义(P>0.05).两组女性患者总有效率[RR=0.96,95％CI(0.88,1.05),P=0.42]、女性患者治愈率[RR=0.91,95％CI(0.78,1.06),P=0.24]、老年患者总有效率[RR=0.96,95％CI(0.84,1.11),P=0.61]、老年患者治愈率[RR=0.90,95％CI(0.54,1.49),P=0.69]比较,差异均无统计学意义.试验组患者便秘[RR=0.59,95％CI(0.42,0.81),P=0.001]、口干[RR=0.65,95％CI(0.51,0.82),P=0.0004]、恶心[RR=0.68,95％CI(0.56,0.83),P=0.0002]、食欲降低[RR=0.74,95％CI(0.55,0.99),P=0.04]的发生率均显著低于对照组,差异均有统计学意义.结论:艾司西酞普兰与度洛西汀治疗抑郁症的有效性相当,但在安全性方面艾司西酞普兰更优.%OBJECTIVE:To systematically evaluate the effectiveness and safety of escitalopram and duloxetine in the treatment of depression, and provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed, Wanfang database,VIP,CNKI and CBM,randomized controlled trials (RCTs) about escitalopram (trial group) and duloxetine (control group) in the treatment of depression were collected. Meta-analysis was conducted by using Rev Man 5.3 software after data extraction and quality evaluation according to bias risk assessment tool recommended by system evaluator manual 5.3. RESULTS:Finally 25 RCTs were included,involving 2621 patients. The results of Meta-analysis showed that there was no statistical significance in total response rate between 2 groups after 1,2,4,6,8 weeks of treatment or cure rate between 2 groupsafter 4,6,8 weeks of treatment (P>0.05). There was no statistical significance in total response rate [RR=0.96,95％CI(0.88, 1.05),P=0.42] or cure rate [RR=0.91,95％CI(0.78,1.06),P=0.24] of female patients,as well as total response rate [RR=0.96, 95％CI(0.84,1.11),P=0.61] or cure rate [RR=0.90,95％CI(0.54,1.49),P=0.69] of elderly patients between 2 groups. The incidence of constipation [RR=0.59,95％CI (0.42,0.81),P=0.001],dry mouth [RR=0.65,95％CI(0.51,0.82),P=0.0004], nausea [RR=0.68,95％CI(0.56,0.83),P=0.0002] and decreased appetite [RR=0.74,95％CI(0.55,0.99),P=0.04] in trial group were significantly lower than control group,with statistical significance. CONCLUSIONS:The effectiveness of escitalopram is similar to duloxetine in the treatment of depression,but the safety of escitalopram is better than duloxetine.