氟西汀治疗脑卒中后抑郁有效性与安全性的系统评价

氟西汀治疗脑卒中后抑郁有效性与安全性的系统评价

易湛苗, 刘芳^*, 翟所迪

1. 北京大学第三医院药剂科, 北京 100191
2. 北京大学药学院药事管理与临床药学系, 北京 100191

收稿日期:2009-09-21 修回日期:2009-11-15 出版日期:2010-01-15 发布日期:2010-01-15
通讯作者: 刘芳*

Efficacy and safety of fluoxetine for the treatment of post-stroke depression:
a meta-analysis

Zhan-Miao Yi, Fang Liu^*, Suo-Di Zhai

1. Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
2. Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing 100191, China

Received:2009-09-21 Revised:2009-11-15 Online:2010-01-15 Published:2010-01-15
Contact: Fang Liu*

摘要/Abstract

摘要： 虽然抑郁症会影响卒中患者的康复甚至生存率, 但经常被忽略或者没有得到很好的治疗, 而且关于氟西汀在这方面的疗效与安全性的研究存在争议。本文旨在系统地评价氟西汀在卒中后抑郁患者中的有效性与安全性。通过系统检索10个生物医学数据库, 搜集和评价卒中后抑郁患者使用氟西汀的随机对照试验, 共纳入11项600名患者的随机对照试验。使用Revman软件进行meta分析, 结果显示氟西汀疗效优于安慰剂, 9项随机对照研究的合并效应显示, 和安慰剂相比, 氟西汀显著减低抑郁评价量表的分值, 权重均数差值 (WMD) 为0.44 (95%可信限为-0.03至0.92)。同时观察到氟西汀的时间依赖效应。没有明确的合并效应表明氟西汀对神经功能和日常生活能力 (ADL) 的恢复有益。其中6个研究报到了氟西汀组和对照组的不良反应率, 合并效应显示两组间无显著差异, 比值比为0.03 (95%可信限为-0.00至0.07) 。本研究表明, 氟西汀有助于缓解卒中后抑郁, 并呈时间依赖性。

关键词: 氟西汀, 卒中后抑郁, meta分析

Abstract: Although depression may affect patients’ recovery and even their survival rate after stroke, it is often overlooked or inadequately managed. And data regarding the treatment efficacy and safety of fluoxetine in this setting are inconsistent. We aimed to systematically assess those two indices in patients with post-stroke depression (PSD). Through a systematic literature search in 10 biomedical databases, 244 articles were first identified, through which we collected and evaluated a total of 600 patients identified from 11 RCTs. The meta-analysis with Revman software indicated that fluoxetine was more effective than placebo, the combined results of 9 RCTs showed that fluoxetine decreased the depression rating scale scores significantly compared with placebo, and the pooled weighted mean difference (WMD) was 0.44 (95% CI -0.03 to 0.92). Moreover, time-dependent effects were also observed. No consistent evidence was found for its positive effects on the recovery of neurological impairments and improvements in activities of daily living (ADL). Six studies reported rate of adverse effects in both fluoxetine groups and control groups and showed no significant difference between them (OR = 0.03, 95% CI -0.00 to 0.07). This meta-analysis suggested that fluoxetine may be effective and safe for patients with PSD and it may have time-dependent effects.

Key words: Fluoxetine, Post-stroke depression, Meta-analysis

中图分类号:

R954

Supporting: ^*Corresponding author. Tel./fax: 86-10-82265740

易湛苗, 刘芳^*, 翟所迪. 氟西汀治疗脑卒中后抑郁有效性与安全性的系统评价[J]. .

Zhan-Miao Yi, Fang Liu^*, Suo-Di Zhai. Efficacy and safety of fluoxetine for the treatment of post-stroke depression:
a meta-analysis [J]. .

参考文献

[1] Paolucci, S.; Antonucci, G.; Grasso, M.G.; Morelli, D.; Troisi, E.; Coiro, P.; Angelis, D.D.; Rizzi, F.; Bragoni, M. Cerebrovasc. Dis. 2001, 12, 264-271.
[2] Kotila, M.; Numminen, H.; Waltimo, O.; Kaste, M. Eur. J. Neurol. 1999, 6, 309-312.
[3] Golomb, B.A.; Vickery, B.G.; Hays, R.D. Pharmacoeconomics. 2001, 2, 155-185.
[4] House, A.; Knapp, P.; Bamford, J.; Vail, A. Stroke. 2001, 32, 696-701.
[5] Ricardo, E.J.; Robert, G.R.; Arndt, S.; Starstein, S. Am. J. Psychiatry. 2003, 160, 1823-1829.
[6] Dam, M.; Tonin, P.; Boni, A.D.; Pizzolato, G.; Casson, S.; Ermani, M.; Freo, U.; Piron, L.; Battistin, L. Stroke. 1996, 27, 1211-1214.
[7] Cheer, S.M.; Goa, K.L. Drugs. 2001, 61, 81-110.
[8] Kong, Y.; Dong, W., Liu, C.F. Neural. Regen. Res. 2007, 2, 162-165.
[9] Chen, Y.; Guo, J.J.; Zhan, S.Y.; Patel, N.C. Ann. Pharmacother. 2006, 40, 2115-2122.
[10] Hackett, M.L.; Anderson, C.S.; House, A.O. Stroke. 2005, 36, 1098-1103.
[11] Bhogal, S.K.; Teasell, R.; Foley, N.; Speechley, M. J. Am. Geriatr. Soc. 2005, 53, 1051-1057.
[12] Ottenbacher, K.J.; Mann, W.C.; Granger, C.V.; Tomita, M.; Hurren, D.; Charvat, B. Arch. Phys. Med. Rehabil. 1994, 75, 1297-1301.
[13] Wade, D.T. Measure of Motor Impairment: Measurement in Neurological Rehabilitation. UK: Oxford University Press. 1992, 154-157.
[14] Greenland, S.; O’Rourke, K. Biostatistics. 2001, 2, 463-471.
[15] Higgins, J.P.T.; Green, S. Cochrane Handbook for Systematic Reviews of Interventions 5.0.1. The Cochrane Collaboration. updated Sep 2008.
[16] Gonzalez-Torrecillas, J.L.; Mendlewicz, J.; Lobo, A. Int. Psychogeriatrics. 1995, 7, 547-560.
[17] Miyai, I.; Reding, M.J. J. Neuro. Rehab. 1998, 12, 5-13.
[18] Robert, G.R.; Schultz, S.K.; Castillo, C.; Kopel, T.; Kosier, T.; Newman, R.M.; Curdue, K.; Petracca, G.; Starkstein, S.E. Am. J. Psychiatry. 2000, 157, 351-359.
[19] Wiart, L.; Petit, H.; Joseph, P.A.; Mazaux, J.M.; Barat, M. Stroke. 2003, 31, 1829-1832.
[20] Fruehwald, S.; Gatterbauer, E.; Rehak, P.; Baumhackl, U. J. Neurol. 2003, 250, 347-351.
[21] Smi, C.K.; Han, S.W.; Kwon, S.U.; Kang, D.W.; Choi, J.M.; Kim, J.S. Stroke. 2006, 37, 156-161.
[22] Li, L.T.; Wang, S.H.; Ge, H.Y.; Chen, J.; Yue, S.W.; Yu, M. J. Altern. Complement. Med. 2008, 14, 841-846.
[23] Jiang, L.X.; Ma, J.D.; Huang, S.P. Her. Med. 2000, 19, 325.
[24] Wu, L.P.; Huang, Y.X.; Zhen, S. Guangxi Univ. J Med. 2007, 24, 294-296.
[25] Wan, S.C.; Chen, W.; Peng, P. Chin. J. Clin. Rehabil. 2003, 7, 3122.
[26] Sun, C.Y.; Zhang, J.X. Chin. J. Behav. Med. Sci. 2003, 12, 398.
[27] Rosenthal, R. Psychosom. Med. 1991, 53, 247-271.
[28] Beasley, C.M.; Masica, D.N.; Potvin, J.H. Psycho-pharmacology. 1992, 107, 1-10.
[29] Hurst, M.; Lamb, H.M. CNS Drugs. 2000, 14, 51-80.