度洛西汀与舍曲林治疗中国抑郁症患者疗效及安全性Meta分析

Efficacy and safety of duloxetine versus sertraline for Chinese depression patients： a meta-analysis

目的 比较度洛西汀与舍曲林治疗中国抑郁症患者的疗效及安全性.方法 对度洛西汀与舍曲林对比治疗抑郁症的随机对照试验进行系统评价,应用循证医学的研究方法,使用统计分析软件Revman 5.2进行Meta分析.结果 18篇随机对照研究符合纳入标准.Meta分析结果显示,治疗后度洛西汀组与舍曲林组的有效率差异无统计学意义（OR=1.28,95%CI：0.94-1.73, P=0.11）;治愈率差异无统计学意义（OR=1.25,95%CI：0.97-1.62, P=0.09）.治疗1、2周后,度洛西汀组与舍曲林组汉密尔顿抑郁量表（HAMD）评分差异有统计学意义（P〈0.05）,度洛西汀起效速度快于舍曲林;治疗8周后,两组HAMD评分差异无统计学意义（P〉0.05）.度洛西汀组疼痛评价量表（MOSPM）的评分较舍曲林组低,差异有统计学意义（P〈0.01）.度洛西汀组失眠发生率低于舍曲林组（RR=0.57,95%CI：0.32-1.00,P〈0.05）,其余常见不良反应差异均无统计学意义（均P〉0.05）.结论 度洛西汀和舍曲林治疗中国抑郁症患者长期疗效相当,但度洛西汀起效快于舍曲林.对伴有疼痛症状的抑郁症的疗效度洛西汀较舍曲林好.在常见不良反应中,度洛西汀较少引起失眠.

Objective To systematically evaluate the efficacy and safety of duloxetine and sertraline for Chinese depression patients.Methods The randomized controlled trials（RCTs）comparing the efficacy and safety of duloxetine and sertraline in the treatment of depression were retrieved from databases and the quality of literature was evaluated.Meta-analysis was performed with the software Revman 5.2.Results Eighteen RCTs involving 1 557 Chinese depression patients were included.The results of Meta-analysis showed that there were no significant differences in efficacy and cure rate between duloxetine and sertraline groups（OR=1.28, 95%CI：0.94 -1.73, P =0.11; OR =1.25,95%CI：0.97 -1.62,P =0.09, respectively）.The Hamilton Depression Scale（HAMD）scores were significantly lower in duloxetine group than those in sertraline group at 1,2 weeks after treatment;however,there were no significant differences at 8-weeks after treatment between duloxetine and sertraline groups.The score of Medical Outcomes Study Pain Measures（MOSPM）in duloxetine group was significantly lower than that in sertraline group（P〈0.01）. The rate of insomnia in duloxetine group was significantly lower than that in sertraline group（RR=0.57, 95%CI：0.32 -1.00, P=0.04）.There were no significant differences in other common side reactions between the two groups（P〉0.05）.Conclusions Duloxetine has similar long term treatment effect as sertraline,but it has a rapid-action profile.Duloxetine is more effective than sertraline in depression with painful physical symptoms;besides,duloxetine is less likely to induce insomnia.