氟西汀治疗卒中后抑郁有效性和安全性的meta分析

Meta-analysis on the efficacy and safety of Fluoxetine in the treatment of post-stroke depression

目的系统评价氟西汀治疗卒中后抑郁(PSD)的有效性和安全性。方法计算机检索PubMed、The Cochrane Library、中国生物医学文献服务系统(CBM)、中国期刊全文数据库(CNKI)、万方数据库(Wanfang Data)、维普中文科技期刊数据库(VIP)中有关氟西汀治疗PSD的文献,检索时限从建库至2020年9月。根据纳入和排除标准筛选文献并提取数据资料,进行文献质量评价,采用RevMan 5.3软件进行meta分析。结果共纳入9个临床随机对照研究,包括763例患者。meta分析结果显示:氟西汀组汉密尔顿抑郁量表评分低于对照组[SMD=-4.11,95%CI(-5.31,-2.91),P<0.00001];氟西汀组美国国立卫生研究院卒中量表评分低于对照组[SMD=-1.50,95%CI(-2.41,-0.59),P=0.001];氟西汀组不良反应发生率与对照组比较,差异无统计学意义[RR=2.11,95%CI(0.05,92.23),P=0.70]。结论氟西汀能改善PSD患者的抑郁症状及神经功能缺损,且不增加不良反应,然而该药物能否在临床广泛应用,尚需开展更多质量更高的研究,以进一步佐证临床疗效。

Objective To systematically evaluate the efficacy and safety of Fluoxetine in the treatment of post-stroke depression(PSD).Methods Literatures related to Fluoxetine in the treatment of PSD from PubMed,The Cochrane Library,CBM,CNKI,Wanfang Data and VIP were searched by computer.The retrieval time limit is from inception to September 2020.The literatures were selected according to the inclusion and exclusion criterias,the data was extracted and the literature quality was evaluated.RevMan 5.3 software was used for meta-analysis.Results A total of 763 patients were included in nine clinical randomized controlled studies.Meta-analysis results showed that the score of Hamilton depression scale in the Fluoxetine group was lower than that in the control group(SMD=-4.11,95%CI[-5.31,-2.91],P<0.00001).The score of national institute of health stroke scale in the Fluoxetine group was lower than that in the control group(SMD=-1.50,95%CI[-2.41,-0.59],P=0.001).There was no significant difference in the incidence of adverse reactions between Fluoxetine group and control group(RR=2.11,95%CI[0.05,92.23],P=0.70).Conclusion Fluoxetine can improve the depressive symptoms and neurological deficits in PSD patients without increasing the adverse reactions.However,whether this drug can be widely used in clinic still needs to carry out more high-quality studies to further prove the clinical efficacy.