抗抑郁药治疗肠易激综合征疗效荟萃分析及治疗适应证探讨

目的通过对抗抑郁药疗效的荟萃分析来探讨抗抑郁药治疗肠易激综合征(IBS)的适应证。方法检索MEDLINE、EMBASE和Cochrane对照研究登记库中IBS患者抗抑郁药治疗的随机对照研究(文献发表时间为2000-01-01-2018-03-31)。以成年IBS患者为研究人群,将抗抑郁药与安慰剂或常规治疗进行对比。以IBS的总体症状或腹痛症状无改善为结局指标,获得抗抑郁药治疗后IBS症状无改善的相对危险度(RR)和95%可信区间(CI),并根据危险差的倒数计算出所需要治疗的患者数(NNT)。对可能影响疗效的主要临床特征(即是否合并心理障碍、腹痛或腹部不适的严重程度、是否难治性IBS)和疗程进行亚组分析。结果纳入12项高质量的随机对照研究进行荟萃分析。与安慰剂或常规治疗相比,当合并抑郁或焦虑时,抗抑郁药治疗后IBS症状无改善的相对危险度是0.45(95%CI 0.26~0.80),NNT为3.7。在抑郁和焦虑未知组,难治性IBS患者抗抑郁药治疗后IBS症状无改善的相对危险度是0.58(95%CI 0.46~0.73),NNT为3.6;中-重度腹痛或腹部不适患者抗抑郁药治疗后IBS症状无改善的相对危险度是0.64(95%CI 0.44~0.93),NNT为4.7。抗抑郁药疗程≥3个月时,治疗后IBS症状无改善的相对危险度是0.66(95%CI0.54~0.81)。结论 IBS患者抗抑郁药治疗的适应证为合并抑郁或焦虑、难治性IBS、表现为中-重度腹痛或腹部不适的IBS患者;推荐疗程至少为3个月。

Antidepressant treatment for irritable bowel syndrome patients:the efficacy analysis and treatment indications

Objective To study the indications of antidepressant treatment for irritable bowel syndrome(IBS)patients based on the efficacy analysis of antidepressants. Methods MEDLINE,EMBASE and the Cochrane Controlled Trials Register were searched(from January 1,2000 to March 1,2018). Randomized controlled trials(RCTs)were examined for the efficacy of antidepressants in adult patients with IBS,and patients on the control arm were required to receive placebo or traditional treatment. The unimprovement of global IBS symptoms or abdominal pain was defined as dichotomous outcomes. Dichotomous symptom data were pooled to obtain a relative risk(RR)of remaining symptomatic states after therapy,with a 95% confidence interval(CI). The number needed to treat(NNT)was calculated from the reciprocal of the risk difference. The main clinical features,which were likely to affect the efficacy(whether being complicated with mental disorder, the severity of abdominal pain or abdominal discomfort, whether its being refractory IBS), and duration of treatment were analyzed in subtypes. Results Twelve RCTs were eligible for inclusion. In the patients with combined depression or anxiety,the RR of unimproved IBS symptoms with antidepressants versus placebo was 0.45(95%CI 0.26-0.80),and the NNT was 3.7. In the group of unawareness of depression and anxiety,and in the patients with refractory symptoms,the RR of unimproved IBS symptoms with antidepressants versus placebo was 0.58(95%CI 0.46-0.73),and the NNT was 3.6;in patients with moderate to severe abdominal pain,the RR of unimproved IBS symptoms with antidepressants versus placebo was 0.64(95%CI 0.44-0.93),and the NNT was 4.7. In the patients with longer duration of treatment(no less than 3 months),the RR of unimproved IBS symptoms with antidepressants versus placebo was 0.66(95%CI 0.54-0.81). Conclusion The indications of antidepressant treatment for IBS patients include being combined with depression or anxiety,refractory IBS,and moderate to severe abdominal pain/discomfort. The no less than 3-month treatment is recommended.