不同抗抑郁药物对卒中后抑郁疗效的网状Meta分析

Network meta-analysis of the efficacy of different drugs in the treatment of post-stroke depression

目的评价不同抗抑郁药物对卒中后抑郁(PSD)的疗效。方法检索PubMed、EMbase、Cochrane Library、中国生物医学文献数据库、中国知网和万方数据库,检索时限为建库至2019年1月。使用Stata 14.2进行网状Meta分析。结果本文最终纳入32个临床研究,共2 644例PSD患者。与安慰剂比较,帕罗西汀(MD=9.34,95%CI:4.39-14.29)、氟西汀(MD=8.63,95%CI:5.51-11.75)、丙米嗪(MD=9.41,95%CI:0.12-18.70)、去甲替林(MD=8.54,95%CI:4.14-12.94)、文拉法辛(MD=6.97,95%CI:2.04-11.90)、传统疗法(MD=6.40,95%CI:1.70-11.11)、依地普仑(MD=6.32,95%CI:1.91-10.73)降低汉密尔顿抑郁量表(HAMD)评分差异有统计学意义,舍曲林、黛力新差异无统计学意义。帕罗西汀治疗PSD较氟西汀(MD=0.71,95%CI:-5.14-6.56)、丙米嗪(MD=0.07,95%CI:-9.38-9.25)、去甲替林(MD=0.80,95%CI:-5.82-7.42)、文拉法辛(MD=2.37,95%CI:-4.61-9.36)、传统疗法(MD=2.94,95%CI:-3.89-9.77)、依地普仑(MD=3.02,95%CI:-3.61-9.65)、舍曲林(MD=6.14,95%CI:-4.98-17.26)和黛力新(MD=6.37,95%CI:-2.11-14.86)存在优势,但无统计学意义。抗抑郁药物对PSD治疗效果从优到差依次为帕罗西汀、氟西汀、丙米嗪、去甲替林、文拉法辛、传统疗法、依地普仑、舍曲林、黛力新。结论帕罗西汀、氟西汀、丙米嗪、去甲替林、文拉法辛、传统疗法、依地普仑均对PSD有疗效,其中帕罗西汀的疗效最优。

Objective To comprehensively evaluate the effects of post-stroke depression(PSD) drug therapy.Methods A systematic search of PubMed, EMbase, Cochrane Library, CBM, CNKI and Wanfang databases. The search time limit was built until January 2019. The network meta-analysis was performed using Stata 14.2.Results This paper finally included 32 clinical studies(a total of 2 644 patients with PSD). Compared with that in placebo group, there was statistical significance of decreased Hamilton depression scale(HAMD) score in paroxetine(MD=9.34, 95%CI: 4.39-14.29), fluoxetine(MD=8.63, 95%CI: 5.51-11.75), imipramine(MD=9.41, 95%CI: 0.12-18.7), nortriptyline(MD=8.54, 95%CI: 4.14-12.94), venlafaxine(MD=6.97, 95%CI: 2.04-11.90), traditional therapy(MD=6.40, 95%CI: 1.70-11.11), escitalopram(MD=6.32, 95%CI: 1.99-10.73), and sertraline and deanxit had no statistical significance. Paroxetine was better than fluoxetine(MD=0.71, 95%CI:-5.14-6.56), imipramine(MD=0.07, 95%CI:-9.38-9.25), nortriptyline(MD=0.80, 95%CI:-5.82-7.42), venlafaxine(MD=2.37, 95%CI:-4.61-9.36), traditional therapy(MD=2.94, 95%CI:-3.89-9.77), escitalopram(MD=3.02, 95%CI:-3.61-9.65), sertraline(MD=6.14, 95%CI:-4.98-17.26) and deanxit(MD=6.37, 95%CI:-2.11-14.86), but there was no statistical significance between them. The sequence of therapeutic effects on PSD was paroxetine, fluoxetine, imipramine, nortriptyline, venlafaxine, traditional therapy, escitalopram, sertraline and deanxit.Conclusion Paroxetine, fluoxetine, imipramine, nortriptyline, venlafaxine, traditional therapy and escitalopram have therapeutic effects on PSD, and paroxetine has the best effect.