西酞普兰联合利培酮治疗难治性抑郁症疗效评价的Meta分析

Meta analysis of efficacy of citalopram combined with risperidone in the treatment of refractory depression

目的 系统评价西酞普兰联合利培酮治疗难治性抑郁症的有效性和安全性.方法 计算机检索PubMed、Cochrane Library、Embase、Lancet、CBM、CNKI、VIP和WanFang Data,并辅以手工检索方法收集国内外相关文献,检索时间截止2016年12月.由2位研究者按纳入和排除标准独立筛选文献、提取资料并评价纳入文献方法学质量后,采用RevMan 5.3软件进行Meta分析.结果 最终共纳入8个随机对照试验（randomized controlled trials,RCTs）,共计711例患者.Meta分析结果显示西酞普兰联合利培酮组在治疗有效率[OR =3.47,95％ CI （2.33,5.16）,P＜0.01]、痊愈率[OR=2.48,95％ CI（1.64,3.76）,P＜0.01]方面优于单用西酞普兰组;治疗后2、4、6、8周联合组汉密尔顿抑郁量表（Hamilton depression scale,HAMD）评分[标准化均数差（standardized mean difference,SMD）=0.65,95％CI （0.39,0.92）,P ＜0.01;SMD =0.59,95％ CI （0.34,0.84）,P＜0.01;SMD=0.62,95％ CI （0.24,0.99）,P=0.001;SMD =0.78,95％ CI （0.27,1.29）,P=0.003]和治疗后2、4、6周联合组HAMA评分[SMD=0.51,95％CI （0.09,0.92）,P =0.02;SMD =0.34,95％ CI （0.09,0.58）,P =0.007;SMD=0.54,95％CI （0.15,0.93）,P=0.007]均优于单用西酞普兰组;治疗后4、6周治疗不良反应量表（treatment emergent symptom scale,TESS）评分[SMD=-0.37,95％ CI（-1.66,0.920）,P=0.580;SMD=-0.19,95％ CI（-0.90,0.51）,P=0.590],2组间差异无统计学意义（P＞0.05）.结论 西酞普兰联合利培酮治疗难治性抑郁症疗效好,且不良反应较单用西酞普兰无明显增加,值得临床推广.

Objective To evaluate comprehensively the efficacy and safety of citalopram combined with risperidone in the treatment of refractory depression.Methods Computer-aided information retrieval was made by using such databases as PubMed,Cochrane Library,Embase,CBM,CNKI,VIP,WanFang and Lancet as well,at the same time,manual data retrieval was also made by searching related literature from both published and unpublished papers,and both at home and abroad.The time span for information retrieval was from the inception to December 2016.After 2 reviewers screened independently the retrieved literature in accordance with the included and excluded selection criteria,and collected the retrieved papers and evaluated methodological the quality of the retrieved literature,meta-analysis was performed by using RevMan 5.3 software.Results Finally,a total of 8 randomized controlled trials （RCTs） involving 711 patients were included in the study.Meta-analyses showed that the effective rate and cure rate of the citalopram combined with risperidone group were respectively [OR =3.47,95％ CI （2.33,5.16）] （P ＜ 0.01） and [OR =2.48,95％CI （1.64,3.76）] （P ＜0.01）,which were superior to those of the simple citalopram group.Following treatment of 2,4,6 and 8 weeks,HAMD scores of the experimental group were respectively [SMD =0.65,95％CI （0.39,0.92）,P ＜0.01;SMD =0.59,95％ CI （0.34,0.84）,P ＜0.01;SMD =0.62,95％ CI （0.24,0.99）,P =0.001;SMD =0.78,95％ CI （0.27,1.29）,P =0.003].After treatment of 2,4 and 6 weeks,HAMA scores of the experimental group were respectively[SMD =0.51,95％ CI （0.09,0.92）,P =0.02;SMD=0.34,95％CI （0.09,0.58）,P=0.007;SMD=0.54,95％CI （0.15,0.93）,P=0.007],which were also superior to those of the simple citalopram group.Following treatment of 4 and 6 weeks,TESS scores of the experimental group were respectively [SMD =-0.37,95％ CI （-1.66,0.92）,P =0.580;SMD =-0.19,95％ CI （-0.90,0.51）,P =0.590].There was no statistical significance when comparisons were made between the 2 groups.Conclusions Current evidence shows that citalopram combined with risperidone could produce good effects on refractory depression,without obvious adverse reactions.For this reason,risperidone could be supplemented clinically,so as to enhance therapeutic efficacy in the treatment of refractory depression.