脑出血内、外科治疗随机对照试验的Meta分析

目的 评价比较内、外科两种方法治疗高血压脑出血的疗效.方法 对所有已发表的脑出血随机对照试验(RCT)进行Meta分析.结果 (1)共纳入13个符合要求的RCT研究,包括脑出血患者2 842例.(2)Meta分析结果显示脑出血内、外科治疗患者死亡率OR合并值在发病后1个月为0.73(0.48,1.13),两组差异无统计学意义(P＞0.05).但在发病3-12个月后OR合并值为0.77(0.64,0.91),外科治疗组明显优于内科治疗组,差异有统计学意义(P＜0.05).(3)发病3个月以后,患者生活依赖的OR合并值为0.84(0.39,1.81),两组差异无统计学意义(P＞0.05),但在发病6-12个月后,外科治疗组患者生活能力明显优于保守治疗组,OR值为0.63(0.41,0.98),差异有统计学意义.结论 外科手术远期疗效优于内科保守治疗,能显著提高脑出血患者存活率,并有效改善日常生活能力.

Abstract：

Objective To evaluate the efficacy between surgical treatment and conservative treatment in intracerebral hemorrhage by meta analysis. Method We identified randomized controlled trials (RCT) of intracerebral hemorrhage. And Meta - analysis was conducted on homogeneous studies.Result Thirteen RCTs(2 842 patients) were included. Meta -analysis was conducted on included studies including surgical treatment or medical treatment for intracerebral hemorrhage patients. The mortality OR (95%CI) values was 0.73 (0.48, 1.13) at the end of 1 month. There was no significant difference of survival rate between two groups ( surgical treatment group and conservative treatment group, P ＞ 0. 05 ). But at the end of 3 - 12 months, the mortality OR ( 95% CI ) values was 0. 77 ( 0. 64,0. 91 ). The difference between two groups was not significant ( P ＜0. 05). The patients dependence OR(95%CI) value was 0.84(0. 39, 1. 81 ) at the end of 3 month. The difference between two groups was not significant( P ＞ 0. 05 ). But at the end of 6 - 12 months, patients dependence OR ( 95% CI ) value was 0. 63 ( 0. 41,0. 98 ). The difference of two groups was significant ( P ＜ 0. 05 ) . Conclusions As compared with conservative treatment, surgical treatment could remarkably decrease long - term mortality, and improve the ability of daily life.     

脑出血内、外科治疗随机对照试验的Meta分析

Objective To evaluate the efficacy between surgical treatment and conservative treatment in intracerebral hemorrhage by meta analysis. Method We identified randomized controlled trials (RCT) of intracerebral hemorrhage. And Meta - analysis was conducted on homogeneous studies.Result Thirteen RCTs(2 842 patients) were included. Meta -analysis was conducted on included studies including surgical treatment or medical treatment for intracerebral hemorrhage patients. The mortality OR (95%CI) values was 0.73 (0.48, 1.13) at the end of 1 month. There was no significant difference of survival rate between two groups ( surgical treatment group and conservative treatment group, P ＞ 0. 05 ). But at the end of 3 - 12 months, the mortality OR ( 95% CI ) values was 0. 77 ( 0. 64,0. 91 ). The difference between two groups was not significant ( P ＜0. 05). The patients dependence OR(95%CI) value was 0.84(0. 39, 1. 81 ) at the end of 3 month. The difference between two groups was not significant( P ＞ 0. 05 ). But at the end of 6 - 12 months, patients dependence OR ( 95% CI ) value was 0. 63 ( 0. 41,0. 98 ). The difference of two groups was significant ( P ＜ 0. 05 ) . Conclusions As compared with conservative treatment, surgical treatment could remarkably decrease long - term mortality, and improve the ability of daily life.     

脑出血内、外科治疗随机对照试验的Meta分析

Objective To evaluate the efficacy between surgical treatment and conservative treatment in intracerebral hemorrhage by meta analysis. Method We identified randomized controlled trials (RCT) of intracerebral hemorrhage. And Meta - analysis was conducted on homogeneous studies.Result Thirteen RCTs(2 842 patients) were included. Meta -analysis was conducted on included studies including surgical treatment or medical treatment for intracerebral hemorrhage patients. The mortality OR (95%CI) values was 0.73 (0.48, 1.13) at the end of 1 month. There was no significant difference of survival rate between two groups ( surgical treatment group and conservative treatment group, P ＞ 0. 05 ). But at the end of 3 - 12 months, the mortality OR ( 95% CI ) values was 0. 77 ( 0. 64,0. 91 ). The difference between two groups was not significant ( P ＜0. 05). The patients dependence OR(95%CI) value was 0.84(0. 39, 1. 81 ) at the end of 3 month. The difference between two groups was not significant( P ＞ 0. 05 ). But at the end of 6 - 12 months, patients dependence OR ( 95% CI ) value was 0. 63 ( 0. 41,0. 98 ). The difference of two groups was significant ( P ＜ 0. 05 ) . Conclusions As compared with conservative treatment, surgical treatment could remarkably decrease long - term mortality, and improve the ability of daily life.     

雷沙吉兰治疗帕金森病随机对照试验的 Meta 分析

目的：系统评价雷沙吉兰治疗帕金森病（PD）的疗效和安全性。方法通过计算机检索及手工检索,全面收集雷沙吉兰治疗帕金森病的符合纳入标准的随机对照试验,按 Cochrane 协作网 Meta 分析的方法进行评价。结果共纳入7个试验（3559例患者）,其中3个为雷沙吉兰与安慰剂对照研究,另外4个为早期启动的和延迟启动的雷沙吉兰对照研究。Meta 分析显示,雷沙吉兰1 mg/d、2 mg/d 治疗对于 PD 患者UPDRS 总分的改善均优于安慰剂（Z =7.99、8.30,P 〈0.00001）;早期启动的1 mg/d 雷沙吉兰治疗对于 PD患者 UPDRS 总分的改善优于延迟启动的1 mg/d 雷沙吉兰治疗（Z =2.18,P =0.03）;早期启动的2 mg/d 雷沙吉兰治疗对于 PD 患者 UPDRS 总分的改善与延迟启动的2 mg/d 雷沙吉兰治疗比较无明显差异（Z =0.63,P =0.53）,二者疗效相当。不良反应主要为晕厥、直立性低血压、跌倒、头晕、头痛、背痛、关节痛、肌肉痛、感染、嗜睡、恶心、疲劳等。不良反应发生率雷沙吉兰与安慰剂相当、早期启动雷沙吉兰治疗与延迟启动雷沙吉兰治疗相当（Z =0.49,P =0.63;Z =1.01,P =0.31）。退出试验患者比率雷沙吉兰与安慰剂相当（Z =1.13,P =0.26）;早期启动雷沙吉兰治疗退出率高于延迟启动雷沙吉兰治疗（Z =2.27,P =0.02）。结论雷沙吉兰治疗能使 PD 患者 UPDRS 总分得到改善,安全性较好。     

重复经颅磁刺激治疗卒中后抑郁随机对照试验Meta分析

目的系统评价重复经颅磁刺激（repetitive transcranial magnetic stimulation ,rTMS）治疗卒中后抑郁的疗效和安全性。方法通过计算机检索、手工检索方法,全面收集重 rTMS治疗卒中后抑郁的随机对照试验（randomized controlled trial ,RCT）,按Cochrane协作网系统评价的方法进行Meta分析。结果共纳入9个试验（664例患者）,包括3个假刺激对照试验和6个空白对照试验。9个试验均采用汉密尔顿抑郁量表（Hamilton Depression Scale ,HAMD）评价治疗期末抑郁的改善,Meta分析结果显示,高频和低频rTMS对抑郁改善程度均优于对照组,差异有统计学意义（低频：MD＝－5.49,95％ CI－10.37～－1.50,P＝0.009;高频：M D＝－7.66,95％ C I －12.09～－3.24,P＝0.0007）;3个评价治疗期末神经功能缺损试验（172例）的Meta分析结果显示,rTMS组明显优于对照组（SMD＝－0.59,95％ CI －0.94～－0.25,P＝0.0007）;5个评价治疗前后生活质量改善的Meta分析结果显示,rTMS组治疗期末的生活质量改善优于对照组（SMD＝1.30,95％ CI 0.93～1.68,P＜0.00001）;5个试验报道了治疗过程中的不良反应,主要是一过性头痛和恶心,Meta分析结果显示,2组差异无统计学意义（RR＝2.93,95％ CI 0.87～9.93,P＝0.08）;仅1个试验（120例）进行长期的随访,结果显示,rTMS组治疗期末抑郁的改善优于对照组,差异有统计学意义（P＜0.05）。结论重复经颅磁刺激能有效改善治疗前后的抑郁状态和生活质量,且不良反应小,未见严重不良反应,但其治疗抑郁的长期效果有待进一步研究。     

益生菌改善抑郁情绪的Meta分析

目的系统评价益生菌对改善抑郁情绪的作用,为抑郁发作的益生菌治疗提供循证参考。方法系统检索PubMed、Embase、中国知网、万方数据库、维普数据库,纳入关于益生菌改善抑郁情绪的随机对照研究(RCT),由两位研究者进行文献筛选并提取数据。采用Stata 16. 0进行Meta分析、敏感性检验及发表偏倚检验,并基于评价工具、抑郁类型及年龄分组进行亚组分析。结果本研究共纳入17项研究,包括1 192例研究对象。随机效应模型分析结果显示,使用益生菌后,治疗组量表评分变化值优于对照组,差异有统计学意义(SMD=-0. 50,95%CI:-0. 80～-0. 21,Z=3. 31,P0. 01)。按照抑郁类型分组的亚组分析中,合并抑郁组、健康组的治疗组与对照组相比差异有统计学意义(合并抑郁组SMD=-0. 33,95%CI:-0. 63～0. 04,Z=2. 21,P=0. 03;健康组SMD=-0. 67,95%CI:-1. 09～-0. 24,Z=3. 07,P0. 01);以年龄分组的亚组分析中,青年组中治疗组与对照组相比差异有统计学意义(SMD=-0. 50,95%CI:-0. 81～-0. 19,Z=3. 18,P0. 01)。结论益生菌对抑郁情绪有一定缓解作用,但其效果受患者年龄、是否合并疾病等多方面的影响。     

氯胺酮治疗难治性抑郁症有效性和安全性的Meta分析

目的:系统评价氯胺酮治疗难治性抑郁症(TRD)的有效性和安全性.方法:计算机检索Cochrane Library、PubMed、EMBase等数据库,搜索有关氯胺酮(试验组)与安慰剂(对照组)治疗TRD的随机对照研究(RCT).结果:最终纳入13项RCT.Meta分析结果显示:试验组治疗后1个月内蒙哥马利抑郁评定量表(...     

经颅直流电刺激对卒中后抑郁疗效的Meta分析

目的 系统评价经颅直流电刺激对卒中后抑郁的治疗效果。方法 检索数据库中从数据库建立至2021年关于tDCS对PSD治疗的临床随机对照试验。采用Cochrane协作网中RCT偏倚风险评价标准进行方法学质量评估,采用Review Manager 5.3软件进行Meta分析。结果 共纳入6项研究,显示tDCS能够明显改善PSD(SMD=1.85,95%CL=1.13～2.57,P<0.00001)。结论 tDCS能够改善PSD,但仍需更多高质量的研究予以验证。     

心理治疗对阈下抑郁疗效的Meta分析

目的系统评价心理治疗对阈下抑郁的疗效。方法检索PubMed、PsycINFO、Embase、Cochrane Library、中国知网数据库(CNKI)、万方数据库,文献检索时间均为建库至2020年4月,纳入心理治疗对阈下抑郁疗效的随机对照试验。结果27个随机对照试验共5503例阈下抑郁患者符合纳入标准。Meta分析结果显示,心理治疗对阈下抑郁的疗效与对照组比较差异有统计学意义[SMD=-0.38,95%CI:(-0.48~-0.28)]。亚组分析结果显示,面谈心理治疗与网络心理治疗对阈下抑郁的疗效与对照组比较差异有统计学意义[SMD=-0.41,95%CI:(-0.52~-0.30);SMD=-0.40,95%CI:(-0.67~-0.13)]。分级治疗对阈下抑郁的疗效与对照组比较差异无统计学意义[SMD=-0.12,95%CI:(-0.27~0.04)],认知行为治疗与行为激活对阈下抑郁的疗效与对照组比较差异有统计学意义[SMD=-0.41,95%CI:(-0.54~-0.28);SMD=-0.44,95%CI:(-0.76~-0.12)]。结论心理治疗对阈下抑郁有疗效,但结果需要更多的非认知行为治疗与大样本试验加以验证。     

卒中后抑郁相关影响因素的Meta分析

目的 探索脑卒中相关危险因素，为卒中后抑郁的早期诊断及预防决策提供依据。方法 标 准化检索万方、知网、维普、Medline、Cochrane 和Embase 有关卒中后抑郁相关性研究的文献，进一步提 取文献中相关因素的比值比（OR）及95%CI, 合并各个相关因素的OR值及95%CI以评估各因素在卒中后 抑郁中的作用。通过Egger''s检验和敏感性分析评估各相关因素的偏倚风险和结果稳定性。结果 Meta 分析结果显示基底节区梗死（OR=2.83）、多病灶（OR=2.76）、额叶梗死（OR=2.47）、高改良Rankin 量表（mRS） 评分（OR=2.17）、缺乏家庭支持（OR=1.48）、高水平超敏C 反应蛋白（OR=1.35）、女性（OR=1.66）、高水平同型 半胱氨酸（OR=1.17）、高水平瘦素（OR=1.16）、高体质指数（BMI）（OR=1.16）、年龄（OR=1.07）为卒中后抑郁 的危险因素，而高受教育水平（OR=0.91）可能对卒中后抑郁具有保护作用。结论 高水平瘦素、高水平 BMI、高mRS 评分、多病灶、基底节区梗死、额叶梗死、缺乏家庭支持、女性、高水平超敏C 反应蛋白、高 水平同型半胱氨酸、年龄是卒中后抑郁的危险因素，高受教育水平可能对卒中后抑郁具有保护作用。     

Early filiform needle acupuncture for poststroke depression: a meta-analysis of 17 randomized controlled clinical trials

OBJECTIVE: To evaluate the effectiveness and safety of filiform needle acupuncture for poststroke depression, and to compare acupuncture with the therapeutic efficacy of antidepressant drugs. DATA RETRIEVAL: We retrieved data from the Chinese National Knowledge Infrastructure(1979–2012), Wanfang(1980–2012), VIP(1989–2012), Chinese Biomedical Literature(1975–2012), PubMed(1966–2012), Ovid Lww(–2012), and Cochrane Library(–2012) Database using the internet. SELECTION CRITERIA: Randomized controlled trials on filiform needle acupuncture versus antidepressant drugs for treatment of poststroke depression were included. Moreover, the included articles scored at least 4 points on the Jadad scale. Exclusion criteria: other acupuncture therapies as treatment group, not stroke-induced depression patients, score 4 points, non-randomized controlled trials, or animal trials. MAIN OUTCOME MEASURES: These were the Hamilton Depression Scale scores, clinical effective rate, Self-Rating Depression Scale scores, Side Effect Rating Scale scores, and incidence of adverse reaction and events. RESULTS: A total of 17 randomized controlled clinical trials were included. Meta-analysis results displayed that after 4 weeks of treatment, clinical effective rate was better in patients treated with filiform needle acupuncture than those treated with simple antidepressant drugs [relative risk = 1.11, 95% confidence interval(CI): 1.03–1.21, P = 0.01]. At 6 weeks, clinical effective rate was similar between filiform needle acupuncture and antidepressant drug groups. At 2 weeks after filiform needle acupuncture, Hamilton Depression Scale(17 items) scores were lower than in the antidepressant drug group(mean difference =-2.34, 95%CI:-3.46 to-1.22, P 0.000,1). At 4 weeks, Hamilton Depression Scale(24 items) scores were similar between filiform needle acupuncture and antidepressant drug groups. Self-Rating Depression Scale scores were lower in filiform needle acupuncture group than in the antidepressant drug group. Side Effect Rating Scale was used in only two articles, and no meta-analysis was conducted. Safety evaluation of the 17 articles showed that gastrointestinal tract reactions such as nausea and vomiting were very common in the antidepressant drug group. Incidence of adverse reaction and events was very low in the filiform needle acupuncture group. CONCLUSION: Early filiform needle acupuncture for poststroke depression can perfectly control depression. Filiform needle acupuncture is safe and reliable. Therapeutic effects of filiform needle acupuncture were better than those of antidepressant drugs.     

Attrition in randomized controlled clinical trials: methodological issues in psychopharmacology.

Attrition is a ubiquitous problem in randomized controlled clinical trials (RCT) of psychotropic agents that can cause biased estimates of the treatment effect, reduce statistical power, and restrict the generalizability of results. The extent of the problem of attrition in central nervous system (CNS) trials is considered here and its consequences are examined. The taxonomy of missingness mechanisms is then briefly reviewed in order to introduce issues underlying the choice of data analytic strategies appropriate for RCTs with various forms of incomplete data. The convention of using last observation carried forward to accommodate attrition is discouraged because its assumptions are typically inappropriate for CNS RCTs, whereas multiple imputation strategies are more appropriate. Mixed-effects models often provide a useful data analytic strategy for attrition as do the pattern-mixture and propensity adjustments. Finally, investigators are encouraged to consider asking participants, at each assessment session, the likelihood of attendance at the subsequent assessment session. This information can be used to eliminate some of the very obstacles that lead to attrition, and can be incorporated in data analyses to reduce bias, but it will not eliminate all attrition bias.