阿米替林治疗功能性消化不良的meta分析

Efficacy of Amitriptyline on Functional Dyspepsia:A Meta-analysis

目的对阿米替林治疗功能性消化不良的疗效及安全性进行评价。方法计算机检索PubMed、Cochrane Library、Web of Science、Embase、中国学术期刊全文数据库、万方数据库、中国生物医学文献数据库等有关阿米替林治疗功能性消化不良的随机对照试验检索时限均为建库截至2019年4月1日。应用RevMan 5.3软件对入选试验进行meta分析。结果共41项随机对照试验符合入选标准,包含4 477例功能性消化不良患者,其中接受阿米替林联合其他药物或单用的共2 250例患者(试验组),使用除阿米替林外其他与试验组相同的药物或安慰剂的共2 227例患者(对照组)。Meta分析结果显示,阿米替林联合促胃动力药物和(或)PPI治疗功能性消化不良的研究的总体有效率显著高于对照组(P<0.05),且可改善上腹痛腹胀、恶心呕吐、烧心反酸等症状(P<0.05),总体不良反应发生率较对照组无显著性差异。结论阿米替林联合促胃动力药物和(或)PPI治疗功能性消化不良有一定的疗效,不良反应可耐受,但由于目前已有的随机对照试验质量较低,建议临床上对于功能性消化不良的患者进行精神症状评估,对于明确伴有精神疾病或者久治不愈的功能性消化不良患者可采用阿米替林作为二线治疗。同时仍需进一步开展更多高质量的研究以确定阿米替林的疗效和安全性。

OBJECTIVE To systematically review the effectiveness and safety of amitriptyline in the treatment of functional dyspepsia(FD).METHODS Databases including PubMed,Cochrane Library,Web of Science,Embase,CNKI and Wanfang Data were searched from inception to April 2019 to collect randomized controlled trials about the effectiveness and safety of amitriptyline in the treatment of FD.Meta-analysis was performed by using RevMan 5.3 software.RESULTS A total of 41 randomized controlled trials,concerning 4 477 FD patients were included,in which contained 2 250 in experiment group and 2 227 in control group.The results of meta-analysis showed that the overall effective rate of amitriptyline combined with gastric motility drugs and/or PPI in the treatment of functional dyspepsia was significantly higher than that of the control group(P<0.05),and could improve some symptoms such as abdominal distention,nausea and vomiting,and heart reacid(P<0.05).In addition,the incidence of ADR in amitriptyline combined with gastric motility drugs and/or PPI had no significant difference with the control group.CONCLUSION Amitriptyline combined with gastric motility drugs and/or PPI has certain efficacy and tolerable adverse reactions in the treatment of FD.However,due to the low quality of the existing randomized controlled trials,it is suggested that patients with chronic FD should assess the psychiatric symptoms to determine whether amitriptyline can be combined in the treatment of FD.Futhermore,more high-quality studies are needed to determine the efficacy and safety of amitriptyline and better guide clinical decision-making.