阿戈美拉汀对脑卒中后抑郁的疗效和安全性Meta分析

Meta-analysis on the Efficacy and Safety of Agomelatine in the Treatment of Post-stroke Depression

目的系统评价阿戈美拉汀治疗脑卒中后抑郁的疗效和安全性。方法计算机检索PubMed、The Cochrane Library、VIP、万方和中国知网数据库,搜集有关阿戈美拉汀联合常规方法治疗脑卒中后抑郁患者的临床研究,检索时限为建库至2021年1月。提取治疗前后各项研究中的汉密尔顿抑郁量表(Hamilton depression scale,HAMD)、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)、Barthel指数、睡眠障碍量表(SDRS)等评分,以及生物因子(BDNF、NGF、NE、5-HT)水平,采用Revman5.3软件进行文献质量评价及Meta分析。结果共纳入9篇文献,合计324例患者。Meta分析结果显示,脑卒中后抑郁患者采用阿戈美拉汀联合常规方法治疗,其HAMD评分较治疗前明显降低(MD=-13.79,95%CI:-18.18~-9.41,P<0.001),且有效率为83%(95%CI:0.52~1.15,P<0.001);NIHSS评分明显降低(MD=-6.35,95%CI:-7.50~-5.20,P<0.001),BI指数明显升高(MD=17.73,95%CI:5.52~29.94,P<0.001),SDRS评分明显降低(MD=-19.71,95%CI:-23.86~-15.57,P<0.001);BDNF水平明显升高(MD=2.95,95%CI:0.90~4.99,P<0.001)。结论当前证据显示,阿戈美拉汀联合常规治疗可有效改善脑卒中后抑郁患者的抑郁症状、神经功能、日常生活能力和失眠症状,且一定程度提升BDNF水平,但受纳入研究数量和质量的限制,所得结果仍需进一步研究证实。

Objective Meta-analysis was performed to evaluate the efficacy and safety of agomelatine in the treatment of post-stroke depression.Methods The databases of PubMed,The Cochrane Library,VIP,Wan Fang and CNKI were searched for clinical studies related to agomelatine combined with conventional therapy in the treatment of patients with post-stroke depression.The retrieval time was from the establishment of the database to January in 2021.The scores of Hamilton depression scale(HAMD),National Institutes of Health Stroke Scale(NIHSS),Barthel index,and sleep disorders scale(SDRS),as well as the levels of neurotrophic factors or neurotransmitters(BDNF,NGF,NE,5-HT),were extracted from all the studies before and after treatment.RevMan 5.3 software was used for literature quality evaluation and Meta-analysis.Results A total of 9 papers,including 324 patients,were contained.The results of Meta-analysis showed that the HAMD scores of patients with post-stroke depressive symptoms treated with agomelatine combined with conventional treatment were significantly lower than those before treatment(MD=-13.79,95%CI:-18.18--9.41,P<0.001),and the effective rate was 83%(95%CI:0.52-1.15,P<0.001).NIHSS scores were significantly lower than those before treatment,and the difference was statistically significant(MD=-6.35,95%CI:-7.50--5.20,P<0.001).SDRS scores were significantly lower than those before treatment,and the difference was statistically significant(MD=-19.71,95%CI:-23.86--15.57,P<0.001).The level of BDNF was significantly higher than that before treatment,and the difference was statistically significant(MD=2.95,95%CI:0.90-4.99,P<0.001).Conclusion The evidence shows that agomelatine combined with conventional treatment can improve depressive symptoms,neurological function,daily living ability and insomnia symptoms effectively in patients with post-stroke depression,and promote BDNF level partly.However,due to the limitation of the numbers and quality of included studies,the results still need to be further confirmed.