抗抑郁药物治疗惊恐障碍的疗效及可接受性的网状Meta分析

Efficacy and acceptability of antidepressants for the treatment of patients with panic disorder:a network Meta-analysis

目的评价抗抑郁药物治疗惊恐障碍的疗效及可接受性。方法电子检索Medline、Embase、Cochrane Library、中国生物医学文献数据库、中国知网等中英文数据库,纳入抗抑郁药物治疗惊恐障碍的头对头随机对照试验,依据Cochrane 5.1.0版质量评价标准评价纳入文献的质量并进行偏倚评价,采用Stata 14.2软件进行网状Meta分析。结果共25个研究进入网状Meta分析,涉及10种药物,分别为米氮平、帕罗西汀、氯丙咪嗪、西酞普兰、氟西汀、文拉法辛、艾司西酞普兰、舍曲林、瑞波西汀、安非他酮。分析结果显示,有效性较好的药物为艾司西酞普兰、氟西汀、文拉法辛、帕罗西汀,但药物两两比较差异均无统计学意义(P>0.05);减分效果最佳的药物为氟西汀、艾司西酞普兰、米氮平、安非他酮,与氯丙咪嗪比较,氟西汀[MD=4.27(1.12,7.43)]、艾司西酞普兰[MD=3.84(1.49,6.19)]、米氮平[MD=3.42(0.83,6.01)]、帕罗西汀[MD=2.81(0.82,4.80)]、文拉法辛[MD=2.06(0.11,4.02)]在减分效果方面具有明显优势,可以显著降低HAMA评分,其他两两比较差异均无统计学意义(P>0.05);耐受性较好的药物是帕罗西汀,其次是文拉法辛、艾司西酞普兰,但药物两两比较差异均无统计学意义(P>0.05)。结论作为治疗惊恐障碍的一线治疗药物,帕罗西汀、文拉法辛、艾司西酞普兰兼具疗效和安全性,为可供选择的有效药物。

Objective To evaluated the efficacy and acceptability of antidepressants for the treatment of panic disorder.Methods We searched Medline,Embase,CBM,CNKI in both English and Chinese databases,for the head-to-head randomized controlled trial of antidepressant treatment for panic disorder.Quality assessment and bias evaluation were conducted with the Cochrane Collaboration’s RevMan 5.1.0software.The network Meta-analysis were conducted with the Stata 14.2 software.Results A total of 25 trials met the inclusion criteria,involving 10 medications:mirtazapine,paroxetine,clomipramine,citalopram,fluoxetine,venlafaxine,escitalopram,sertraline,reboxetine,amfebutamone.The result of analysis showed that the drugs with good effectiveness were escitalopram,fluoxetine,venlafaxine and paroxetine,but there were no statistical significance in pairwise comparison of drugs(P>0.05).The more prominent antidepressants for the effect of score reduction were fluoxetine,mirtazapine,escitalopram,amfebutamone.Compared with clomipramine,fluoxetine[MD=4.27(1.12,7.43)],escitalopram[MD=3.84(1.49,6.19)],mirtazapine[MD=3.42(0.83,6.01)],paroxetine[MD=2.81(0.82,4.80)]and venlafaxine[MD=2.06(0.11,4.02)]had obvious advantages in the effect of score reduction,which could reduce the score of Hamilton Anxiety Rating Scale(HAMA)significantly.There were no statistical significance in other pairwise comparisons of these drugs(P>0.05).The drug with good tolerance was paroxetine,followed by venlafaxine and escitalopram,but there was no significant difference in pairwise comparison of these drugs(P>0.05).Conclusions As the first-line drugs for the treatment of panic disorder,paroxetine,venlafaxine and escitalopram are effective drugs with both efficacy and safety.