柴胡类方联合选择性5-羟色胺再摄取抑制剂治疗卒中后抑郁疗效与安全性的Meta分析

Clinical Effect of Bupleuri Radix-Contained Prescriptions Combined with Selective Serotonin Reuptake Inhibitors on Post-Stroke Depression and Its Safety:A Meta-analysis

目的:系统评价柴胡类方联合5-羟色胺再摄取抑制剂(SSRIs)治疗卒中后抑郁疗效与安全性。方法:计算机检索中国知网(CNKI)、维普中文科技期刊(VIP)、万方数据知识服务平台(Wanfang)、中国生物医学文献服务系统(SinoMed)、Cochrane Library、Embase及PubMed数据库中有关柴胡类方联合SSRIs治疗卒中后抑郁的随机对照试验。采用Revman5.4软件对纳入的临床研究进行偏倚风险质量评估和Meta分析。结果:共纳入19篇文献,共涉及患者1 645例,试验组840例,对照组805例。Meta分析结果显示,试验组在改善汉密尔顿抑郁量表(HAMD)评分[MD=-4.06,95%CI (-4.76,-3.36),P<0.000 01]、美国国立卫生院脑卒中量表(NIHSS)评分[MD=-3.18,95%CI (-4.49,-1.87),P<0.000 01]、Barthel指数评估量表评分[MD=5.57,95%CI (0.90,10.23),P=0.02]、日常生活能力评定量表评分(P<0.05)方面优于对照组,但在提高血清BDNF[MD=3.83,95%CI (-1.05,8.72),P=0.12]方面无明显优势。2组均未见严重不良反应。漏斗图结果提示HAMD评分指标存在一定的发表偏倚。结论:柴胡类方联合SSRIs治疗卒中后抑郁较单纯SSRIs治疗效果更显著,具有较高安全性。但鉴于纳入文献质量较低,结论仍需纳入更多高质量的随机对照试验加以进一步验证。

Objective:To systematically evaluate the clinical effect of Bupleuri Radix-Contained Prescription combined with selective serotonin reuptake inhibitors(SSRIs) on post-stroke depression and its safety.Methods:The randomized controlled trials on Bupleuri Radix-Contained Prescriptions combined with SSRIs for post-stroke depression were retrieved by computer from such databases as China National Knowledge Infrastructure(CNKI),Chinese Science and Technology Journal Database(VIP),Wanfang Data,Chinese Biomedical Literature Service System(SinoMed),Cochrane Library,Embase and PubMed.The included clinical studies were given risk of bias analysis and Meta-analysis by software Revman 5.4.Results:A total of 19 documents were included in this Meta-analysis,involving 1 645 patients.These patients were divided into the trial group and the control group,with 840 and 805 cases respectively.The Meta-analysis showed that the improvements in the scores of Hamilton Depression(HAMD) Scale[MD=-5.26,95% CI(-6.32,-4.20),P<0.000 01],National Institute of Health Stroke Scale(NIHSS)[MD=-3.18,95%CI(-4.49,-1.87),P<0.000 01],Barthel Index [MD=5.57,95%CI(0.90,10.23),P=0.02] and Activity of Daily Living(ADL) Scale in the trial group were better than those in the control group,but with no obvious advantages in the increase of serum BDNF[MD=3.83,95%CI(-1.05,8.72),P=0.12].No serious adverse reactions seen in the two groups.The funnel plot suggested that there was certain bias in HAMD scoring indexes.Conclusion:Compared with those of simple SSRIs,Bupleuri Radix-Contained Prescription combined with SSRIs for post-stroke depression has better administration safety and a more significant clinical effect.But the quality of selected documents is not good enough,more high-quality randomized controlled trials are needed for further confirmation.