喹硫平与利培酮治疗中国老年精神分裂症有效性及安全性对比的Meta分析

Efficacy and Safety of Quetiapine and Risperidone for Senile Schizophrenia in China: a Meta-analysis

目的:通过Meta分析方法比较喹硫平和利培酮治疗中国老年精神分裂症的有效性及安全性。方法:计算机检索PubMed、The Cochrane Library、Embase、SinoMed、CNKI、WanFang Data和VIP数据库,搜集喹硫平与利培酮治疗中国老年精神分裂症的随机对照试验(RCT),检索时限均从建库至2018年7月31日。由两名研究者独立筛选文献、提取资料并对纳入研究进行偏倚风险评估后,采用RevMan 5.3软件进行Meta分析。结果:共纳入8个RCTs,共731例患者。Meta分析结果显示,喹硫平与利培酮治疗中国老年精神分裂症的临床有效率的差异无统计学意义[OR=1.22,95%CI(0.77,1.92),P>0.05]。纳入的研究中两组药物治疗4周、8周和12周后PANSS评分差值的差异均无统计学意义(P>0.05)。在不良反应方面,喹硫平组的锥体外系反应[OR=0.17,95%CI(0.08,0.36),P<0.00001]和体重增加[OR=0.40,95%CI(0.20,0.80),P<0.05]等药品不良反应发生率低于利培酮组,而喹硫平组的血压下降[OR=2.75,95%CI(1.26,6.01),P<0.05]和嗜睡[OR=3.38,95%CI(1.52,7.53),P<0.01]等药品不良反应发生率较高,在心血管系统、肝功能、头晕头痛、恶心呕吐和失眠发生率方面,两组的差异无统计学意义(P>0.05)。结论:喹硫平与利培酮治疗中国老年精神分裂症疗效相当,药品不良反应各有不同。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective:To evaluate the safety and efficacy of quetiapine and risperidone in the treatment of senile schizophrenia in China by Meta-analysis.Methods:PubMed,The Cochrane Library,Embase,SinoMed,CNKI,WanFang Data,VIP databases were electronically searched to collect randomized controlled trial(RCT)about quetiapine and risperidone for senile schizophrenia in China from inception to July 2018.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.RevMan 5.3 software was used for Meta-analysis.Results:A total of 8 RCTs involving 731 patients were included.The results of meta-analysis showed that:there was no significant difference of the clinical efficacy rate of quetiapine and risperidone(OR=1.22,95%CI 0.77 to 1.92,P>0.05).There were no significant differences in PANSS scores between the two groups at 4,8 and 12 weeks after the study(P>0.05).In terms of adverse drug reactions,quetiapine group had lower incidence rate of the extrapyramidal reaction(OR=0.17,95%CI 0.08 to 0.36,P<0.00001)and weight gain(OR=0.40,95%CI 0.20 to 0.80,P<0.05)than risperidone group,but the quetiapine group had higher incidence rate of blood pressure drop(OR=2.75,95%CI 1.26 to 6.01,P<0.05)and somnolence(OR=3.38,95%CI 1.52 to 7.53,P<0.01)than risperidone group.There were no significant differences between two groups in incidence rate of insomnia,nausea,vomiting,liver function abnormal differences had no statistical significance(P>0.05).Conclusion:Quetiapine is equivalent to risperidone in the treatment of senile schizophrenia in China,but there are differences in drug-related adverse reactions.Due to limited quality and quantity of the included studies,more high quality studies are needed to verify above conclusion.