草酸艾司西酞普兰治疗卒中后抑郁疗效的Mate分析

The Efficacy of Escitalopram Oxalate in the Treatment of Post-Stroke Depression of Meta-Analysis

摘要: 目的：系统评价草酸艾司西酞普兰治疗卒中后抑郁(post-stroke depression)的效果。方法：检索PubMed、Embase、Cochrane Library、Web of Science、SinoMed、中国知网、万方数据库、维普数据库等数据库，限定时间为2010年1月~2018年10月31日，文献类型为随机对照，实验组为草酸艾司西酞普兰(escitalopram oxalate ESO)治疗或其联合心理治疗或其他常规治疗，对照组为其他抗抑郁药物或其联合心理治疗或其他常规治疗。对所提结果进行文献偏倚质量评价以及资料提取后用stata15.0软件进行meta分析。结果：依研究要求最终纳入15篇文献，总样本n = 1287例，其实验组n = 645例，对照组n = 642例。HAMD于第2、4、6、8周实验组相对对照组评分分别为[SMD = −0.372 95% CI (−0.944 0.200), p = 0.202]、[SMD = −1.191 95% CI (−1.894 −0.489), p = 0.001]、[SMD = −0.213 95% CI (−0.463 0.036), p = 0.093]、[SMD = −0.995 95% CI (−1.736 −0.254), p = 0.008]，第2周和第6周无统计学意义，可能与观察时间、评分准确度以及治疗措施有关，而第4、8周有统计学意义，组间差异有统计学意义,实验组比对照组能明显降低PSD抑郁程度，同时NIHSS评分[SMD = −1.287 95% CI (−1.775 -0.800), p = 0.000]，组间差异有统计学意义，实验组较对照组神经功能恢复较好。MMSE评分[SMD = 1.405 95% CI (1.104 1.707), p = 0.000]，组间差异有统计学意义，实验组较对照组智力及认知功能缺损恢复较好。以及实验组无效率明显低于对照组[SMD = 3.784 95% CI (1.836 7.7986), p = 0.000]，差异有统计学意义。研究组的异质性较大，经亚组分析发现与发表年份有关，纳入研究组在治疗期间均出现不良反应，但均在一周内消失，能继续完成实验。结论：实验组较对照组能显著降低PSD的抑郁程度、促进神经功能恢复以及提高认知水平，但是本研究相对纳入研究文献质量水平有限，结论有待进一步验证。

Abstract: Objective: To systematically evaluate the efficacy of escitalopram oxalate in the treatment of post-stroke depression (post-stroke depression). Methods: The databases of PubMed, Embase, Cochrane Library, Web of Science, SinoMed, China Knowledge Network, Wanfang database and VIP databases were retrieved, which was limited to January 2010-October 31, 2018, and the document type was randomized, the experimental group was treated with oxalic acid escitalopram (escitalopram oxalate ESO) or its combined psychotherapy or other routine treatment, and the control group was other antidepressants or their combined psychotherapy or other routine treatment. The results of literature bias quality evaluation and data extraction were used to carry out meta analysis with stata15.0 software. Results: According to the research requirements, 15 literatures were finally included, the total sample n = 1287 case, the experimental group n = 645 case, the control group n = 642 case. The scores of HAMD in the experimental group in the 2, 4, 6 and 8 weeks were compared with those of the control group, [SMD = −0.372 95% CI (−0.944 0.200), p = 0.202], [SMD = −1.191 95% CI (−1.894 −0.489), p = 0.001], [SMD = −0.213 95% CI (−0.463 0.036), p = 0.093], [SMD = −0.995 95% CI (−1.736 −0.254), p = 0.008]. The statistical significance of the 2nd week and the 6th Friday may be related to the observation time, the accuracy of the score and the treatment measures, and the 4th and 8th weeks have statistical significance. The experimental group can significantly reduce the degree of PSD depression compared with the control group. At the same time, the NIHSS score [SMD = −1.287 95% CI (−1.775 −0.800), p = 0.000], the difference between the groups was statistically significant, and the experimental group was better than the control group. The MMSE score [SMD = 1.405 95% CI (1.104 1.707), p = 0.000], the difference between the groups was statistically significant, and the experimental group recovered better than the control group. The effectiveness of the experimental group was significantly lower than that of the control group [SMD = 3.784 95% CI (1.836 7.7986), p = 0.000], and the difference was statistically significant. The heterogeneity of the study group was large. The subgroup analysis found that it was related to the year of publication. The study group had adverse reactions during the treatment period, but all disappeared within one week and the experiment could be continued. Conclusion: The experimental group can significantly reduce the Depression degree of PSD, promote the recovery of neurological function and improve the cognitive level compared with the control group, but the quality level of the literature is limited and the conclusion needs to be further verified.