暴露反应预防治疗强迫症随机对照试验的Meta分析

Meta-analysis of randomized controlled trials of exposure and response prevention for obsessive compulsive disorder

目的系统评价暴露反应预防(exposure and response prevention,ERP)对强迫症(obsessive compulsive disorder,OCD)的干预效果。方法检索PubMed、Web of Science Core Collection、EBSCO、Cochrane Library、Embase、Science Direct、万方数据、中国知网及维普全文数据库,搜集ERP治疗OCD相关的随机对照研究。纳入符合标准的随机对照研究,以耶鲁-布朗强迫量表作为主要结局指标,焦虑、抑郁情绪量表作为次要结局指标,同时对纳入文献进行文献质量评价及数据提取。采用Review Manager 5.3和Stata 16.0软件对所提取数据进行Meta分析。结果共纳入27篇文献,共计1239例患者,其中ERP组599例,对照组640例。Meta分析结果显示,对改善患者强迫症状,ERP组显著优于空白对照(MD=-6.55,95%CI:-8.75~-4.35,P<0.001),也显著优于氯丙咪嗪(MD=-5.88,95%CI:-8.20~-3.56,P<0.001),但与CBT疗效差异无统计学意义(MD=0.21,95%CI:-1.62~2.04,P=0.82),且在干预后的随访期内ERP和CBT的疗效无差异(MD=0.41,95%CI:-2.45~3.27,P=0.78)。对改善患者抑郁情绪,ERP可以有效改善患者抑郁情绪(SMD=-0.45,95%CI:-0.74~-0.17,P=0.002),但与CBT差异无统计学意义(SMD=-0.05,95%CI:-0.27~0.16,P=0.62)。对改善患者焦虑情绪,与对照组差异无统计学意义(SMD=-0.17,95%CI:-0.56~0.23,P=0.41)。结论ERP在改善OCD患者的强迫症状、抑郁情绪方面具有较好的可行性,但对于改善焦虑情绪,随访期内保持长期疗效未得到验证。

Objective To systematically evaluate the intervention effect of exposure and response prevention(ERP)on obsessive compulsive disorder(OCD).Methods PubMed,Web of Science Core Collection,EBSCO,Cochrane Library,Embase,Science Direct,Wanfang Data,China National Knowledge Infrastructure and VIP-CSTJ were used to collect randomized controlled studies related to ERP for OCD.Randomized controlled studies that met the criteria were included,with the score of Yale-Brown obsessive-compulsive scale as the primary outcome indicator and the scores of anxiety and depression scale as secondary outcome indicators,while the included literatures were evaluated for literature quality and data extraction.Review Manager 5.3 and Stata 16.0 softwares were used to conduct Meta-analysis on the extracted data.Results Twenty-seven studies with a total of 1239 patients were included,and 599 cases in the ERP group and 640 cases in the control group.Meta-analysis results showed that the efficacy of ERP group was significantly better than that of blank control group(MD=-6.55,95%CI:-8.75--4.35,P<0.001)and significantly better than chlorpromazine control group treatment(MD=-5.88,95%CI:-8.20--3.56,P<0.001)for improving patients'obsessive-compulsive symptoms,but not significantly different from CBT intervention(MD=0.21,95%CI:-1.62-2.04,P=0.82),and the efficacy of ERP and CBT had no significant during the post-intervention follow-up period(MD=0.41,95%CI:-2.45-3.27,P=0.78).For improving patients'depressed mood,ERP was effective in improving patients'depressed mood(SMD=-0.45,95%CI:-0.74--0.17,P=0.002),but not significantly different from CBT(SMD=-0.05,95%CI:-0.27-0.16,P=0.62).For improving anxiety,the efficacy of ERP group was not different from that of control group(SMD=-0.17,95%CI:-0.56-0.23,P=0.41).Conclusion ERP has good feasibility in improving obsessive-compulsive symptoms and depression in patients with OCD.However,long-term efficacy was not verified for improving anxiety and maintaining long-term efficacy during the follow-up period.