选择性5-羟色胺再摄取抑制剂治疗帕金森病伴抑郁有效性与安全性的系统评价

Efficacy and Safety of Selective Serotonin Reuptake Inhibitors for Parkinson's Disease Patients with Depression:A Systematic Review

目的系统评价5-羟色胺再摄取抑制剂(SSRIs)治疗帕金森病伴抑郁的有效性与安全性。方法计算机检索The Cochrane Library(2014年第5期)、Pub Med、EMbase、CNKI、VIP和Wan Fang Data数据库,全面收集SSRIs治疗帕金森病伴抑郁的随机对照试验(RCT),检索时限均为从建库至2014年5月。由2位评价员按纳入与排除标准独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Rev Man 5.2软件进行Meta分析。结果共纳入12个研究。Meta分析结果显示:与安慰剂相比,SSRIs治疗帕金森病伴抑郁在有效率[RR=2.18,95%CI(1.60,2.97),P<0.000 01]和不良事件相关的失访发生率[OR=3.02,95%CI(1.04,8.79),P=0.04]方面,差异有统计学意义。但两组不良事件发生率差异无统计学意义。结论当前证据显示,SSRIs治疗帕金森病伴抑郁有效。受纳入研究数量和质量所限,该结论尚需开展更多大样本、高质量的RCT进一步验证。

Objective To systematically review the efficacy and safety of selective serotonin reuptake inhibitors（SSRIs） in the treatment of Parkinson＇s disease patients with depression. Methods The Cochrane Library（Issue 5, 2014）, Pub Med, EMbase, CNKI, VIP and Wan Fang Data databases were searched from inception to May 2014 for randomized controlled trials（RCTs） investigating the efficacy and safety of SSRIs for Parkinson＇s disease patients with depression. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using Rev Man 5.2 software. Results A total of 12 RCTs were included. The results of meta-analysis showed that the efficacy of SSRIs was better than placebo（RR=2.18, 95%CI 1.60 to 2.97, P〈0.000 01） and the dropouts rates of SSRIs were higher than placebo（OR=3.02, 95%CI 1.04 to 8.79, P=0.04）. However, the incidence rate of adverse events between the SSRIs group and the placebo group was not statistically different. Conclusion Current evidence indicates that SSRIs are effective for the Parkinson＇s disease patients with depression. Because of the limitation of quantity and quality of included studies, large-scale multi-center RCTs are required to confirm these findings.