米氮平与帕罗西汀治疗中国抑郁症患者疗效及安全性的Meta分析

目的：比较米氮平与帕罗西汀在治疗中国抑郁症患者中的疗效及安全性。方法：对米氮平与帕罗西汀对比治疗抑郁症随机对照试验进行系统评价，应用循证医学的研究方法，使用统计分析软件Revman5．2进行Meta分析。结果：14篇随机对照研究满足纳入标准。Meta分析结果表明：①治疗6周后米氮平组与帕罗西汀组的有效率差异无统计学意义[OR=I．15，95％CI（0．79，1．68），P=O．46]，其第6周治愈率差异亦无统计学意义[0R=1．17，95％CI（0．86，1．58），P=O．24]；疗程为l、2周时，米氮平治疗组与帕罗西汀治疗组汉密尔顿抑郁量表（HAMD）评分差异有统计学意义，即米氮平起效速度优于帕罗西汀；疗程分别为4、6周时，两组HAMD评分差异无统计学意义，即两者疗效差异无统计学意义。②不良反应：米氮平组嗜睡、体质量增加发生率高于帕罗西汀组[RR=2．40，95％CI（1．33，4．32）；RR=IO．06，95％CI（4．55，22．22）]，口干、性功能障碍、恶心和失眠发生率低于帕罗西汀组[RR=O．45，95％CI（0．31，0．67）；RR=O．07，95％CI（0．03，0．17）；RR=O．12，95％CI（0．04，0．34）；RR=O．11，95％CI（0．04，0．27）]。其余常见不良反应差异无统计学意义。结论：两者长期疗效相当，但米氮平起效快于帕罗西汀。在常见不良反应中，米氮平更易引起嗜睡及体质量增加，帕罗西汀更易引起口干、恶心、失眠及性功能障碍，其余不良反应两组差异无统计学意义。

Meta-analysis of the efficacy and safety of mirtazapine versus paroxetine for depression in Chinese patients

Objective： To assess the efficacy and safety of mirtazapine and paroxetine on depression inChinese patients. Methods： The randomized controlled trials （RCT） comparing the efficacy of mirtazapine and paroxetine in the treatment of depression were systematically evaluated. Evidence-based medicine research meth- ods were applied and statistical analysis software Revman 5.2 was used. Results： Fourteen studies of RCT met inclusion criteria. The results of Meta-analysis showed that： ① After 6-weeks treatment, both the efficiency and cure rates had no significant difference between the mirtazapine and the paroxetine groups with [OR=1.15, 95% CI （0.79, 1.68）, P=0.46] and [OR=l.17, 95% CI （0.86, 1.58）, P=0.24]. The Hamilton Depression Scale （HAMD） scores were significantly lower in mirtazapine group than that in paroxetine group at 1 and 2 weeks after treatment, and there were no significant differences between mirtazapine group and paroxetine group at 4 and 6 weeks after treatment. ②Adverse reactions： The somnolence and weight gain rate of the mirtazapine group were higher than those of the paroxetine group with RR=2.40 and 95% CI 1.33 to 4.32, RR=10.06 and 95% CI 4.55 to 22.22. And paroxetine more easily led to dry mouth, nausea, insomnia and sexual dysfunction with RR=0.45 and 95% CI 0.31 to 0.67; RR--0.07 and 95% CI 0.03 to 0.17; RR=0.12 and 95% CI 0.04 to 0.34; RR=0.11 and 95% CI 0.04 to 0.27 than mirtazapine. The other common side reactions had no significantly different between the two groups. Conclusion： Mirtazapine has similar long term treatment effect as paroxetine, but it has a rapid-action profile. Mirtazapine can more easily induce somnolence and weight gain, and is with lower dry mouth, nausea, insomnia and sexual dysfunction rate when compared with paroxetine. And there is no significant difference between two group in other common side reactions.