文拉法辛与选择性5-HT再摄取抑制剂治疗脑卒中后抑郁的疗效和安全性Meta分析

目的 比较文拉法辛与选择性5-HT再摄取抑制剂（selective serotonin reuptake inhibitors,SSRIs）治疗脑卒中后抑郁对照研究期间疗效和安全性的差异.方法 计算机检索1990年1月～2012年12月的PubMed、Medline数据库、万方数据库、维普数据库、中国期刊全文数据库（CNKI）数据库,按照纳入和排除标准选择相关随机重复对照试验.在提取资料和评价质量后用Review Manager 5.2进行Meta分析,评价文拉法辛和SSRIs治疗脑卒中后抑郁过程中有效率、治愈率、治疗后量表评分及不良反应等的差异.结果 共纳入8项研究,合计574例患者.Meta分析结果显示,文拉法辛治疗脑卒中后抑郁的有效率和治愈率均优于SSRIs [Z=2.56,P＜0.05,OR=2.08,95％CI：1.19～3.65,P=0.010; Z=2.16,P＜0.05,OR=1.56,95％CI：1.04～2.35,P=0.030];文拉法辛治疗脑卒中后抑郁后第2、4、8周HAMD量表评分均优于SSRIs（WMD=-3.19,95％CI：-4.62～-1.77,P＜0.001; WMD=-1.52,95％CI：-2.34～-0.71,P＜0.001; WMD=-2.42,95％CI：-3.99～-0.85,P＜0.001）;两组不良反应差异均无统计学意义（P均＞0.05）.结论 文拉法辛与SSRIs均是治疗脑卒中后抑郁的合适药物,文拉法辛治疗效果略优于SSRIs.

A Meta-analysis for Comparison of Efficacy and Safety of Venlafaxine and Selective Serotonin Reuptake Inhibitors in Treatment of Post Stroke Depression

Objective To compare the efficacy and safety of venlafaxine and SSRIs in treatment of post stroke depression.Methods PubMed,Medline,Wanfang,VIP and CNKI digital journal full-text database from January 1990 to December 2012 were retrieved in order to collect clinical randomized controlled trials regarding the effect of venlafaxine and SSRIs on treatment in post stroke depression patients.Statistical analysis was performed by Meta-analysis using Review Manager 5.2.The differences in effective rate,cure rate,scale score and adverse reactions of venlafaxine and SSRIs were evaluated.Results Eight articles were included and contains total 574 patients.The total effective rate and cure rate of venlafaxine were higher than that of SSRIs[Z =2.56,P ＜ 0.05,OR =2.08,95％ CI：1.19～3.65,P=0.010; Z=2.16,P＜0.05,OR=1.56,95％ CI：1.04 ～ 2.35,P=0.030].The2nd,4th and 8th week HAMD scale scores of venlafaxine were better than SSRIs in the treatment of post stroke depression（WMD =-3.19,95％ CI：-4.62 ～ 1.77,P＜0.001; WMD=-1.52,95％CI：-2.34～-0.71,P＜0.001; WMD=-2.42,95％CI：-3.99～-0.85,P＜0.001）.Therewere no differences in adverse reactions of venlafaxine and SSRIs in the treatment of post stroke depression （all P ＞ 0.05）.Conclusion Venlafaxine and SSRIs are both appropriate drugs for the treatment of post stroke depression,but the effects of venlafaxine was better than SSRIs.