国内抗抑郁药治疗精神分裂症抑郁疗效与安全性Meta分析

The efficacy and safety of antidepressants in the treatment of depression in patients with schizophrenia in China:a meta-analysis

目的评价抗抑郁药治疗精神分裂症抑郁疗效与安全性。方法系统检索万方数据库、维普中文科技期刊数据库、中国生物医学文献数据库和中国学术期刊全文数据库,检索时间截至2017年9月17日,检索关键词为“精神分裂症”“抑郁”“随机”“对照”。根据纳入标准及排除标准筛选文献,选取治疗前后汉密尔顿抑郁量表(HAMD)减分值为主要疗效指标,简明精神病性评定量表(BPRS)或阳性和阴性综合征量表(PANSS)减分值为次要疗效指标。结果共纳入10项随机对照研究,844例患者。Meta分析结果显示:疗效方面,研究组治疗前后HAMD减分值高于对照组(P<0.01);不同抗抑郁药的研究组疗效均优于对照组(P<0.01)。研究组和对照组治疗前后PANSS、BPRS减分值比较差异无统计学意义(P>0.05)。安全性方面,研究组与对照组治疗后TESS分值比较差异无统计学意义(P>0.05)。结论精神分裂症抑郁患者应用抗抑郁药可改善抑郁症状,无恶化精神病性症状的风险,且耐受性良好。鉴于纳入研究局限性,结论仍需谨慎看待。

Objective To assess the efficacy and safety of antidepressants in the treatment of depression in patients with schizophrenia.Methods Systematical search was conducted on Wanfang Data,CQVIP,CBM and CNKI till September 17th,2017,with keywords“schizophrenia”“depression”“randomized”“controlled”.Retrieved literatures were screened according to the predefined inclusion and exclusion criteria.The subtraction score of Hamilton Depression Scale(HAMD)was chosen as primary outcome,and subtraction scores of Brief Psychiatric Rating Scale(BPRS)or Positive and Negative Syndrome Scale(PANSS)were chosen as secondary outcomes.Results A total of 10 randomized controlled trials involving 844 patients were finally included in this meta-analysis.The results of meta-analysis showed that,the subtraction score of HAMD in study group was significantly higher than that in control group(P<0.01),and the efficacies of different antidepressants in study group were all significantly better than those in control group(P<0.01).There was no significant difference between the two groups in subtraction scores of PANSS or BPRS(P>0.05).No significant difference was found between the two groups in the scores of Treatment Emergent Symptoms Scale(TESS)(P>0.05).Conclusion Antidepressants may be effective in the treatment of depression in patients with schizophrenia with a low risk of exacerbation of psychosis and adverse effects.Regarding the poor quality of included studies,the results should be treated with caution.