利培酮与传统药物治疗Tourette综合征疗效及安全性的Meta分析

A Meta-analysis of the effectiveness of risperidone versus traditional agents for Tourette's syndrome

目的:系统评价利培酮与传统药物治疗Tourette综合征的有效性与安全性。方法:依据制定的检索策略搜集利培酮与传统药物治疗Tourette综合征随机对照试验的文献,以Jadad评分法进行文献质量评价,应用异质性检验、Meta分析、敏感性分析、亚组分析、漏斗图分析等方法统计相关数据。结果:共检索到符合条件的随机对照研究文献12篇。大部分纳入研究属低质量文献,存在明显异质性,对其中11篇文献(n=741)疗效的Meta分析结果显示:利培酮疗效与传统药物差异无统计学意义,其漏斗图近似对称,不存在发表偏倚,敏感性分析及亚组分析也得相似结果;利培酮的总体不良反应较轻,其锥体外系反应、植物神经系统不良反应、中毒反应和药物不良反应量表评分均明显低于对照组,其他不良反应与对照组差异无统计学意义。结论:利培酮治疗Tourette综合征的疗效可能与传统药物相当,安全性较好,但本次Meta分析结果效度较低。

Objective：To evaluate the efficacy and safety of risperidone versus traditional agents in treating Tourette＇s syndrome.Methods：Randomized,controlled trials（RCTs） of risperidone versus traditional agents for Tourette＇s syndrome were identified,and eligible studies were included according to our established strategy.Besides methodological quality of inclusive trials,assessed by the Jadad scale,heterogeneity test,Meta-analysis,funnel plot analysis,subgroup analysis and sensitivity analysis were used to analyze the data.Results：A total of 12 RCTs were included,with most trials of low methodological quality and high heterogeneity.Meta-analysis from 11 of the identified RCTs,involving total 741 patients,showed that there was no significant difference in efficacy between risperidone and traditional agents,based on the results of sensitivity analysis,and analyses of a haloperidol subgroup and a domestic-foreign subgroup.The funnel plots was approximately symmetrical,indicating little publication bias.Risperidone presented mild side effects overall,including extrapyramidal symptoms（EPS）,autonomic nervous system symptoms,toxic reactions and the Treatment Emergent Symptom Scale（TESS） score of the treatment group were significantly less than those of control.Conclusion：Risperidone appears to have the same efficacy and appropriate safety as traditional agents in treating Tourette＇s syndrome.Because of the low validity of the results,we are searching for support from the more RCTs with higher methodological quality.