齐拉西酮与阿立哌唑治疗成人首发精神分裂症的系统评价

Systematic review of ziprasidone and aripiprazole in treatment of adult firstepisode schizophrenia

目的系统评价齐拉西酮与阿立哌唑治疗成人首发精神分裂症疗效与安全性差异,为临床用药提供参考。方法计算机检索Pubmed、Medline、中国生物医学文献数据库(CBM)、中国学术期刊全文数据库(CNKI)、维普中文期刊全文数据库(VIP)和万方数据库中齐拉西酮与阿立哌唑对照治疗成人首发精神分裂症的临床随机对照试验(RCT),从建库至2019年7月;提取数据,用Rev Man 5.3软件对各效应指标进行Meta-分析。结果纳入11项RCTs,共计965例首发精神分裂症患者。Meta-分析结果显示:2组阳性症状与阴性症状量表总评分变化值差异无统计学意义,总有效率差异有统计学意义[RR=1.09,95%CI(1.01,1.17),P<0.05];2组失眠发生率[RR=0.44,95%CI(0.23,0.86,P<0.05]、锥体外反应发生率[RR=2.41,95%CI(1.13,5.17)]比较差异均有统计学意义,其他不良反应发生率无统计学意义。结论齐拉西酮与阿立哌唑对成人首发精神分裂症患者的阳性与阴性症状均有明显改善,其中齐拉西酮可能有更为明显临床效果,但锥体外系反应发生率也相对较高;在治疗过程中,两组患者均有不同程度的不良反应发生,但患者均可耐受,未影响继续治疗。

Objective To systematically review the efficacy and safety of ziprasidone and aripiprazole in the treatment of adult firstepisode schizophrenia,and to provide evidence-based reference for clinical drug use.Methods Clinical randomized controlled trial of ziprasidone and aripiprazole in the treatment of adult first-episode schizophrenia in Pub Med,Medline,CBM,CNKI,VIP,and Wanfang Database searched by computer,time limit to July 2019.Extraction and analysis of data according to inclusion and exclusion criteria.Meta-analysis of effect Indexes with Rev Man 5.3 Software.Results A total of 965 patients with first-episode schizophrenia were included in 11 items of RCTs.The results of Meta-analysis showed that there was no significant difference in the total score of PANSS between the two groups at the end of treatment,there was significant difference in the total effective rate between the two groups[RR=1.09,95%CI(1.01,1.17),P<0.05].Security aspects:there was significant difference in the incidence of insomnia[RR=0.44,95%CI(0.23,0.86)]and extrapyramidal reaction[RR=2.41,95%CI(1.13,5.17)]between the two groups(P<0.05),there was no significant difference in the incidence of other adverse reactions.Conclusion Ziprasidone and aripiprazole significantly improved the positive and negative symptoms of adult first-episode schizophrenia,among which ziprasidone may have more obvious clinical effect,but the incidence of extrapyramidal reaction was also relatively high.In the course of treatment,the two groups of patients had different degrees of adverse reactions,but the patients were tolerable and did not affect the continued treatment.