度洛西汀与舍曲林治疗中国老年抑郁症患者的疗效与安全性的Meta分析

Meta-analysis of efficacy and safety of duloxetine versus sertraline in treatment of geriatric depression patients in China

目的系统评价度洛西汀与舍曲林治疗中国老年抑郁症患者的疗效与安全性。方法计算机检索Pub Med、EMbase、中国知网、维普全文数据库、中国生物医学文献数据库和万方数据库中关于度洛西汀与舍曲林治疗老年抑郁症疗效与安全性的随机对照试验(RCTs),采用Cochrane协作网推荐的Rev Man5.0软件对各效应指标进行Meta分析。结果共纳入16项研究,合计1 269例老年抑郁症患者。Meta分析结果显示:度洛西汀组患者总有效率显著高于舍曲林组[OR=1.60,95%CI(1.10,2.33),P=0.01];治疗2周末度洛西汀组患者汉密尔顿抑郁量表(HAMD)评分显著低于舍曲林组[MD=-2.25,95%CI(-3.50,-1.00),P=0.000 4];治疗6周或8周末度洛西汀组患者HAMD评分与舍曲林相当,两组差异无显著意义[MD=-0.64,95%CI(-1.46,0.17),P=0.12]。在不良反应发生率方面,度洛西汀组患者失眠发生率显著低于舍曲林组[OR=0.44,95%CI(0.20,0.97),P=0.04];其余不良反应的发生率差异无显著意义(P>0.05)。结论度洛西汀治疗老年抑郁症的疗效优于舍曲林,起效快,且患者失眠的发生率更小。

AIM To systematically evaluate the efficacy and safety of duloxetine versus sertraline in the treatment of geriatric depression patients in China. METHODS The randomized controlled trials（RCTs） of the duloxetine versus sertraline in the treatment of geriatric depression were searched from Pub Med, EMbase,CNKI, VIP, CBM and Wanfang Database. According to the Cochrane Systematic Review, the meta-analysis was carried out by using Rev Man 5.0 software. RESULTS A total of 16 RCTs were included, involving 1 269 patients. The response rate was higher in the duloxetine group than that in the sertraline group（ OR = 1.60,95% CI（1.10, 2.33）, P = 0.01）. After 2 weeks of treatment, the Hamilton depression scale（HAMD） score in the duloxetine group was significantly lower than that in the sertraline group（MD =-2.25, 95%CI（-3.50,-1.00）, P = 0.000 4）. Whereas, there was no significant difference of the HAMD score in the two groups after6 or 8 weeks of treatment（MD =-0.64, 95%CI（-1.46, 0.17）, P = 0.12）. Furthermore, the incidence of insomnia in the duloxetine group was lower than that in the sertraline group（OR = 0.44, 95%CI（0.20, 0.97）,P = 0.04）. However, there was no significant difference in the other adverse effects（P 〉0.05）. CONCLUSION Duloxetine is more effective than sertraline in the treatment of geriatric depression patients in China, with a rapid onset of action and a lower incidence of insomnia.