加巴喷丁治疗带状疱疹后遗神经痛疗效的Meta分析

Meta-analysis of gabapentin in the treatment of postherpetic neuralgia

目的系统评价加巴喷丁治疗带状疱疹后遗神经痛的疗效和安全性。方法计算机检索美国国立医学图书馆(PubMed)、英国Cochrane图书馆随机对照临床试验资料库、荷兰医学文摘(EMBASE),以及中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)、中国知识基础设施工程(CNKI)和万方数据库,并手工检索相关杂志,由两位研究者独立进行质量评价及数据分析,RevMan 5.0统计软件对数据进行Meta分析。结果根据Cochrane 5.0.2版随机对照临床试验质量评价标准,共纳入5项随机对照临床试验计1225例带状疱疹后遗神经痛患者。结果显示,加巴喷丁组患者平均每日疼痛评分改变高于安慰剂组(SMD=0.920,95%CI:1.330~0.520;P=0.000);简易McGill疼痛问卷平均视觉印象评分改变高于安慰剂组(SMD=2.650,95%CI:3.410~1.890;P=0.000);平均每日睡眠干预评分改变高于安慰剂组(SMD=2.480,95%CI:3.750~1.200;P=0.000)。加巴喷丁组与安慰剂组失访率差异无统计学意义(P=0.240)。治疗期间常见药物不良反应为头晕、嗜睡、水肿等。结论现有临床证据表明,加巴喷丁治疗带状疱疹后遗神经痛疗效显著,治疗保留率高;但应注意其所引起的头晕、嗜睡、水肿等药物不良反应。

Objective To evaluate the effects an d tolerability of gabapentin in the treatment of postherpetic neuralgia(PHN).Metho dsThe ran domize d controlle d trials(RCTs) of gabapentin for the treatment of PHN were retrieve d from PubMe d, Cochrane Central Register of Controlle d Trials,EMBASE, Chinese Biology Me dicine(CBM), VIP, China National Knowle dge Infrastructure(CNKI) an d Wanfang Data. Two reviewers in depen dently evaluate d the quality of the inclu de d articles an d abstracte d the data. Meta analysis was performe d using RevMan 5.0.ResultsAccor ding to the enrollment criteria, 5 prospective, ran domize d controlle d clinical trials inclu ding 1225 subjects were finally selecte d. The mean changes for average daily pain score were significant in gabapentin group compare d with placebo group(SMD = 0.920, 95%CI: 1.330- 0.520; P = 0.000), as well as the mean change for Short Form McGill Pain Questionnaire(SF MPQ) visual analogue scale(SMD = 2.650, 95%CI: 3.410- 1.890; P = 0.000) an d average daily sleep intervention score(SMD = 2.480, 95%CI: 3.750- 1.200; P =0.000). There was no significance between gabapentin group an d placebo group in the with drawl rate(P >0.05). The common a dverse reactions during gabapentin treatment inclu de d dizziness(OR = 3.710, 95%CI:2.530-5.430; P = 0.000), somnolence(OR = 2.430, 95%CI: 1.530-3.860; P = 0.000) an d peripheral e dema(OR = 13.570, 95%CI: 4.190-43.970; P = 0.000).ConclusionIt is in dicate d clinically that gabapentin is effective an d well tolerate d for the treatment of postherpetic neuralgia with high retention rate. However,a dverse reactions, such as dizziness, somnolence an d e dema, shoul d be pai d attention.