抗抑郁药对冠心病合并抑郁患者疗效及炎症因子影响的Meta分析

Effects of antidepressants on efficacy and inflammatory factors in patients with coronary heart disease with depression:a meta-analysis

目的系统评价抗抑郁药选择性5-羟色胺再摄取抑制药(SSRI)对冠状动脉粥样硬化性心脏病(以下简称冠心病)合并抑郁患者疗效及炎症因子的影响,为抗抑郁药治疗冠心病合并抑郁提供现代药理依据。方法用计算机检索中国知网、万方数据库、维普全文数据库、PubMed和The Cochrane Library建库起至2019年12月关于抗抑郁药治疗CHD合并抑郁的临床随机对照试验,对符合质量标准的研究结果进行Meta分析。采用RevMan 5.3软件进行Mate分析。结果最终纳入12项研究,纳入研究对象1 124例,Meta分析结果显示:与对照组比较,试验组患者的C反应蛋白[SMD=-0.85(95%CI:-1.32,-0.37)]、白细胞介素-6[SMD=-1.22(95%CI:-1.49,-0.95)]、白细胞介素-8[SMD=-1.17(95%CI:-1.48,-0.87)]、肿瘤坏死因子-α[SMD=-2.04(95%CI:-2.30,-1.78)]均降低;试验组冠心病有效率优于对照组[OR=1.23(95%CI:1.01,1.51)],心肌梗死再发率低于对照组[OR=0.3(95%CI:0.12,0.74)];抑郁量表评分低于对照组[SDS评分:SMD=-2.04(95%CI:-2.87,-1.20);HAMD评分:SMD=-4.73(95%CI:-6.23,-3.23)]。结论文献证据表明,SSRI类抗抑郁药可有效降低冠心病合并抑郁患者CRP、IL-6、IL-8、TNF-α水平,临床疗效确切。

Objective To evaluate the impact of antidepressant drugs(SSRIs)on the efficacy and inflammatory factors in patients with coronary heart disease(CHD)with depression,and to provide modern pharmacological basis for antidepressant drugs in the treatment of CHD with depression..Methods Data of China National Knowledge Infrastructure,Wanfang database,VIP database,PubMed,and the Cochrane Library database on randomized controlled trials about antidepressant drugs in the treatment of CHD with depression from the establishment of the database to December 2019 was researched,and the results that met the quality standards were analyzed with meta-analysis.RevMan5.3 software was used to perform the meta-analysis.Results A total of 1124 patients were included in 12 studies.Compared with the control group,meta-analysis showed that C-reactive protein[SMD=-0.85,(95%CI:-1.32,-0.37)],interleukin-6[SMD=-1.22,(95%CI:-1.49,-0.95)],interleukin-8[SMD=-1.17,(95%CI:-1.48,-0.87)],and tumor necrosis factor-alpha[SMD=-2.04,(95%CI:-2.32,-1.75)]were decreased in the antidepressant drugs group.The treatment of antidepressant drugs group was superior to the control group[RR=1.23,(95%CI:1.01,1.51)],the recurrence rate of myocardial infarction in the antidepressant group was lower than the control group[RR=0.3,(95%CI:0.12,0.74)],and the score of depression scale was lower than that of the control group[SDS scale:SMD=-2.04,(95%CI:-2.87,-1.20);HAMD scale:SMD=-4.73,95%CI:(-6.23,-3.23)],and the differences were statistically significant.Conclusions According to the existing literature,SSRIs antidepressant drugs do have certain effect on treating CHD with depression and effectively reduce the levels of CRP,IL-6,IL-8,and TNF-α.