非典型抗精神病药物相关代谢不良反应的系统评价和 meta-分析

摘要

Objective:To assess the metabolic side effects of the following atypical antipsychoties head-to-head:amisulpride,olanzapine,aripiprazole,quetiapine,risperidone,ziprasidone.Methods:We searched the MED-LINE,EMBASE,Cochrane Library,PubMed,CNKI,Web of science,Sinomed,WANGFANG DATA databases for randomized,blineded studies comparing the above mentioned atypical antipsychoties in the treatment of schizophre-nia or related disorders.At last three reviewers extracted the data independently.All the data would be analysed with meta ananlysis and the analysis software of the RevMan 5.1 provided by Cochrane network.Results:There were 49 studies in which 45 were written in English and 4 were written in Chinese included in the review.Olanzapine pro-duced statistically significantly more weight gain than all other second-generation antipsychotics.Risperidone pro- duced significantly more weight gain than amisulpride.Olanzapine produced statistically significantly more increase in glucose levels from baseline to endpoint than all other second-genetation antipsychotics.Risperidone produced statistically significantly more increase in glucose levels from baseline to endpoint than aripiprazole,quetiap-ine.Olanzapine produced statistically significantly more increase in cholesterol than aripiprazole,risperidone and zi-prasidone.Quetiapine produced significantly more increase in cholesterol than risperidone and ziprasi-done.Risperidone produced significantly more increase in cholesterol compared to aripiprazole and ziprasidone.Conclusion:Some atypical antipsychoties lead to substantially more metabolic side effects than other a-typical antipsychoties.When choosing an atypical antipsychotic agent for an individual patient these side effects with their potential cause of secondary diseases should be weighed against efficacy and characteristics of the individual patient.%目的：采用系统综述的方法评价非典型抗精神病药物（齐拉西酮、阿立哌唑、奥氮平、利培酮、氨磺必利、帕利哌酮、喹硫平）对精神分裂症患者代谢指标（体质量、血糖、总胆固醇）的影响。方法：检索 Medline 网络数据库（MEDLINE），世界医学文献数据库（PubMed），荷兰医学文摘（EM-BASE），循证医学图书馆（Cochrane Library），中国期刊全文专题数据库（CNKI），美国科学引文索引网络版数据库（Web of science），中国生物医学文献数据库（Sinomed），维普全文电子期刊（VIP）。由三名研究人员根据纳入／排除标准独立筛选、评价文献。应用 Cochrane 协作网提供的 RevMan5.1软件进行数据处理。结果：共纳入文献49篇。对各代谢指标的变化值采用连续性变量的合并平均差（defferencs of means，MD）值及其95％CI 表示，存在异质性的研究进行亚组分析。结果显示奥氮平引起的体质量增加大于氨磺必利、阿立哌唑、喹硫平、利培酮和齐拉西酮，利培酮引起的体质量增加大于氨磺必利；奥氮平引起的血糖升高水平大于氨磺必利、阿立哌唑、喹硫平、利培酮和齐拉西酮，利培酮引起的血糖升高水平大于阿立哌唑、喹硫平；奥氮平引起的胆固醇升高大于阿立哌唑、利培酮、齐拉西酮，喹硫平引起的胆固醇升高大于利培酮、齐拉西酮，利培酮引起的胆固醇升高大于阿立哌唑、齐拉西酮。结论：某些非典型抗精神病药物与其他非典型抗精神病药物相比更显著的导致代谢副反应。在选择某种非典型抗精神病药物作为患者的治疗药物时，必须充分评估、权衡患者的个体特征、潜在引起代谢疾病的危险因素及其药物疗效。