快速色氨酸耗竭试验对SSRIs药物治疗后抑郁症患者的心境和睡眠脑电图影响的系统评价和Meta分析

摘要

Objective To evaluate the effects of rapid tryptophan depletion (TD) on mood and sleep electroencephalogram in subjects with remitted depression on selective serotonin reuptake inhibitors (SSRIs) by the methods of systematic review and Metaanalysis. Methods We searched PubMed,Cochrane Library,Web of Science,Embase,CBM,CNKI,VIP and WF to identify clinical randomized controlled trials evaluating the effects of rapid tryptophan depletion on SSRIs treated remitted depression. The quality of the included studies was critically assessed and the data analyses were performed by the Cochrane Collaborationt's RevMan 4.2. Results Two high-quality studies with Jadad score over 3 points were included. The systematic review results showed that the total and free plasma tryptophan concentrations of TD group decreased significantly comparing with controlled group. Meta-analysis showed that HRSA-19 score [WMD 1.37,95％CI(0.76,1.99),P＜0.001],confusion mood of POMS subscale [WMD 1.17,95％CI(0.44,1.91),P=0.002],TST[WMD127,95％CI(1.5,23.9),P=0.03],SL[WMD-8.11,95％CI(-12.24, -3.98),P=0.01] ,RD[WMD 0.17,95％CI(0.04,0.31) ,P=0.01] ,SI[WMD 2.52,95％CI(-0.02,5.07) ,P=0.05] were significantly different between the TD group and controlled group. Conclusion Based on the current evidence,TD can reduce the plasma tryptophan concentrations and temporary reverse the depression and confusion moods in depression patients treated with SSRIs. Meanwhile, administration of a TD can reduce RL and increase REM percentage and REM density. Due to the poor quality of the included trials, more high-quality RCTs are needed.%目的 通过系统评价和Meta分析方法对比不同研究中快速色氨酸耗竭(TD)试验对经选择性5-羟色胺(5-HT)再摄取抑制剂(SSRIs)药物治疗后抑郁症患者的心境和睡眠脑电图的影响,以研究TD试验在该类抑郁症患者中作用的有效性.方法 计算机检索PubMed、Cochrane图书馆、Web of Science、Embase、CBM、CNKI等相关国内外数据库,全面搜集将TD试验用于经SSRIs药物治疗后抑郁症患者研究的所有临床随机对照研究(RCT),按照Jadad标准对纳入文献进行质量分析,并使用RevMan 4.2软件进行Meta分析,对不能合并的数据结果进行系统评价.结果 最终纳入2篇高质量RCT研究,Jadad评分均在3分以上.系统评价结果显示,TD组研究对象体内色氨酸浓度明显降低,达到了色氨酸耗竭的标准.Meta分析结果显示,TD组患者在汉密尔顿焦虑量表-19(HRSA-19)评分[WMD 1.37、95%CI(0.76,1.99)、P<0.001]、心境量表(POMS)中的迷惑评分[WMD 1.17、95%CI(0.44,1.91)、P=0.002]、睡眠相关分析中的TST值[WMD 127、95%CI(1.5,23.9)、P=0.03]、SL值[WMD -8.11、95%CI(-12.24,-3.98)、P=0.01]、RD值[WMD 0.17、95%CI(0.04,0.31)、P=0.01]以及S1值[WMD 2.52、95%CI(-0.02,5.07)、P=0.05]与对照组比较差异有统计学意义(P<0.05).结论 本研究结果证明TD试验能够诱导经SSRIs药物治疗后的抑郁症患者出现抑郁情绪及迷惑情绪,同时能影响该类患者的睡眠周期相关参数,包括缩短快动眼潜时、增加快动眼期比例、增加快动眼期内动眼频率等.而对于其他检测指标,目前尚没有足够的证据能够证明其组间差异性.受纳入研究质量限制,上述结果还有待开展更多高质量的临床RCT试验来进一步证实.