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抗精神病药物治疗抽动障碍有效性和安全性的Meta分析
杨静张伶俐廖恒俞丹杨春松
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摘要:
目的 本研究采用Meta 分析的方法,评估各种抗精神病药物治疗抽动障碍的有效性和安 全性。方法 计算机检索Cochrane 图书馆、PubMed、EMBASE 中国生物医学文献数据库(CBM)、中国期 刊全文数据库(CNKI)、中国科技期刊全文数据库(VIP)、万方数据库,并查看纳入文献清单和相关系统评 价的参考文献,全面收集抗精神病药物治疗抽动障碍的随机对照试验(RCT),对研究结果进行Meta分析, 采用Stata 软件进行统计分析。结果 纳入60 项研究,涉及4 077 例患者,年龄2~65 岁,研究论文发表 时间为1978—2015 年。各研究的样本量为4~180 例(中位数为61 例)。改善抽动症状评分方面,利培 酮比氟哌啶醇(P=0.54)、阿立哌唑比氟哌啶醇(P=0.45)、盐酸硫必利比氟哌啶醇(P=0.52)、氟哌啶醇比哌 咪清(P=0.67)、奥氮平比氟哌啶醇(P=0.15)、哌咪清比安慰剂(P=0.06),组间差异均无统计学意义。喹硫 平优于氟哌啶醇,阿立哌唑优于盐酸硫必利,利培酮和氟哌啶醇优于安慰剂(P均< 0.05),组间差异有统 计学意义。42 项研究报道了不良反应,非典型抗精神病药物耐受性较好,无严重不良反应。结论 典 型抗精神病药物能治疗抽动症状,效果明显,但不良反应较多,临床应用受到限制;非典型性抗精神病 药物(利培酮、阿立哌唑、奥氮平、齐拉西酮、喹硫平)能有效改善抽动症状,且耐受性较好,其中利培酮 和阿立哌唑是研究证据相对充足的有效药物,喹硫平是具有较好前景的药物,齐拉西酮、奥氮平与喹硫 平有一定疗效,但研究证据较缺乏。抗精神病药物的远期疗效和安全性有待高质量的研究来证实。
关键词:  抗精神病药  抽动障碍  Meta 分析
DOI:10.3969/j.issn.1009-6574.2018.06.004
基金项目:国家自然科学基金项目(81373381)
Comparative efficacy and safety of antipsychotic drugs for tic disorders: a systematic review and Metaanalysis
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Abstract:
Objective This study evaluated the efficacy and safety of various antipsychotic drugs in the treatment of tic disorders by Meta analysis. Methods RCTs evaluating antipsychotic drugs for TDs were identified from PubMed, Embase, Cochrane library, four Chinese database, relevant reference lists and the references of systematic reviews. We used Stata to perform meta-analysis. Results After removing duplicates, screening titles and abstracts, and reading full texts, 60 RCTs met the inclusion criteria, Total of 4 077 patients were included. The age of participants ranged from 2 to 65 years. The publication year was between 1978 and 2015. The sample size ranged from 4 to 180( median 61). There was no statistical significant difference in improving tic severity between the groups of risperidone vs haloperidol( P=0.54), aripiprazole vs haloperidol( P=0.45), tiapride hydrochloride vs haloperidol( P=0.52), piperidin vs haloperidol( P=0.67), olanzapine vs haloperidol( P=0.15), piperidin vs placebo( P=0.06). Quetiapine was better than haloperidol, aripiprazole was better than tiapride hydrochloride, risperidone and haloperidol were superior to placebo in improving the tic symptom score, and the differences were statistically significant( P<0.05). Totally 42 RCTs reported adverse reactions. Atypical antipsychotic drugs were well tolerated without serious adverse effects. Conclusions Typical antipsychotics were efficacious in the reduction of tic severity, however the adverse effects( AE) restricted its clinical application. Atypical antipsychotics( risperidone, aripiprazole, olanzapine, ziprasidone, quetiapine) significantly improve tic symptoms with fewer AEs. The efficacy of risperidone and aripiprazole were supported by strong evidence and quetiapine is a promising therapy for TDs. Ziprasidone and olanzapine are also effective, but the evidence is lacking. The current evidence of antipsychotics in the treatment of TDs is lacking and the quality is not high, long-term efficacy and safety need to be confirmed in further.
Key words:  Antipsychotic agents  Tic disorder  Meta-analysis

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