非典型抗精神病药物联合选择性5-羟色胺再摄取抑制剂治疗难治性强迫症疗效性与安全性的网状meta分析
A network meta-analysis of the efficacy and safety of atypical antipsychotics combined with selective serotonin reuptake inhibitors in the treatment of refractory obsessive-compulsive disorderMa Mingyue,Ji Feng
投稿时间:2021-01-12  修订日期:2021-04-01
DOI:
中文关键词:  非典型抗精神病药  选择性5-羟色胺再摄取抑制剂  难治性强迫症  网状meta分析
英文关键词:Refractory Obsessive-Compulsive Disorder  Atypical antipsychotics  Selective serotonin reuptake inhibitors  Network Meta-analysis
基金项目:精神病与精神卫生专业学位硕士研究生临床能力的评价标准与体系的量化研究(SDYY18195)
作者单位地址
马明悦 济宁医学院精神卫生学院 山东省济宁市任城区济岱路1号济宁市精神病防治院
吉峰* 济宁医学院精神卫生学院 山东省济宁市任城区建设南路45号济宁医学院精神卫生学院
刘燕 济宁医学院精神卫生学院 
高洪彩 济宁医学院公共卫生学院 
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中文摘要:
      目的 采取网状Meta分析的方法评价7种非典型抗精神病药物联合选择性5-羟色胺再摄取抑制剂(SSRI)治疗难治性强迫症的疗效性与安全性。方法 计算机检索CNKI、万方数据知识服务平台、VIP、CBM、PubMed、EMbase和Cochrane Library数据库,按照纳入及排除标准搜集所有非典型抗精神病药物联合SSRIs治疗难治性强迫症的随机对照试验,检索时间为建库至2020年6月,由两名研究者筛选文献、筛选资料及评价纳入研究的偏倚风险,对符合标准的研究采用Stata15.0软件进行数据分析。结果 共纳入36篇RCT,7种非典型抗精神病药物(阿立哌唑、奥氮平、喹硫平、利培酮、氨磺必利、齐拉西酮、帕利哌酮),包括2362例患者。网状Meta分析结果显示:在总有效率方面,累计排序概率曲线下面积排序结果依次为奥氮平+SSRIs、帕利哌酮+SSRIs、氨磺必利+SSRIs、利培酮+SSRIs、喹硫平+SSRIs、齐拉西酮+SSRIs、阿立哌唑+SSRIs、单纯使用SSRIs、安慰剂+SSRIs。在Y-BOCS评分方面,排序结果依次为奥氮平+SSRIs、帕利哌酮+SSRIs、氨磺必利+SSRIs、喹硫平+SSRIs、阿立哌唑+SSRIs、齐拉西酮+SSRIs、利培酮+SSRIs、单纯使用SSRIs、安慰剂+SSRIs。在HAMA评分方面,排序依次为氨磺必利+SSRIs、阿立哌唑+SSRIs、喹硫平+SSRIs、利培酮+SSRIs、SSRIs。在TESS评分方面,排序依次为氨磺必利+SSRIs、单纯使用SSRIs、帕利哌酮+SSRIs、喹硫平+SSRIs、齐拉西酮+SSRIs、利培酮+SSRIs、阿立哌唑+SSRIs、安慰剂+SSRIs。结论 非典型抗精神病药物联合SSRIs治疗难治性强迫症均优于单独使用SSRIs类药物,其中以奥氮平疗效最佳,氨磺必利安全性最高。
英文摘要:
      Objective To evaluate the efficacy and safety of 7 atypical antipsychotics combined with SSRIs in the treatment of refractory obsessive-compulsive disorder by means of network meta-analysis. Methods Computer search of CNKI, WanFang Data, VIP, CBM, PubMed, EMbase and Cochrane Library databases, and collect all atypical antipsychotics combined with SSRIs based on inclusion and exclusion criteria. Randomized controlled trials for the treatment of obsessive-compulsive disorder. The retrieval time is from the establishment of the database to June 2020. Two researchers independently screen the literature, screen the data and evaluate the risk of bias in the included studies. The studies that meet the standards are carried out using Stata 15.0 software data analysis. Results A total of 36 RCTs were included, including 7 atypical antipsychotics (Aripiprazole, Olanzapine, Quetiapine, Risperidone, Amisulpride, Ziprasidone, Paliperidone), including 2362 patients. The results of the network meta-analysis showed that: in terms of total effective rate, the order of the SUCAR sorting results showed that Olanzapine+SSRIs, Paliperidone+SSRIs, Amisulpride+SSRIs, Risperidone+SSRIs, Quetiapine+SSRIs, Zipra- sidone+SSRIs, Aripiprazole+SSRIs, SSRIs, Placebo+SSRIs. In terms of Y-BOCS score,the order is Olanzapine+SSRIs, Paliperidone+SSRIs, Amisulpride+SSRIs,Quetiapine+SSRIs,Aripiprazole+SSRIs, Ziprasidone + SSRIs, Risperidone+SSRIs, SSRIs,Placebo + SSRIs.In terms of HAMA score, the order is Amisulpride+SSRIs, Aripiprazole+SSRIs, Quetiapine+SSRIs, Risperidone+SSRIs, SSRIs. In terms of TESS score, the order is Amisulpride + SSRIs, SSRIs, Paliperidone + SSRIs, Quetiapine + SSRIs, Ziprasidone + SSRIs, Risperidone + SSRIs, Aripiprazole + SSRIs, Placebo + SSRIs. Conclusion Atypical antipsychotics combined with SSRIs are better than SSRIs in treating refractory obsessive-compulsive disorder. Olanzapine has the best effect and Amisulpride has the highest safety.
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