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抗精神病药物所致的运动系统相关不良反应的Meta分析
何欢王翠婷李娜孙东良杨静
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摘要:
目的 系统评价抗精神病药物对精神障碍患者所致的运动系统相关不良反应。方法 计 算机检索PubMed、EMBASE、Cochrane 图书馆、Cochrane 临床对照试验数据库、CNKI、VIP,CBM 及万 方数据库,搜集各类抗精神病药物与安慰剂或其他精神病药物对照比较治疗精神病的随机对照试验 (RCT),检索时间均从建库至2017 年11 月。按 Cochrane 系统评价的方法评价纳入研究质量,对同质研究 采用RevMan 5.3 进行Meta 分析,对数据不能合并者,则进行描述性的定性分析。结果 本研究共纳入 81 篇RCT,共21 810 例患者。针对出现的运动系统相关不良反应频率,帕金森症方面,利培酮大于喹硫 平;锥体外系反应方面,奥氮平、氟哌啶醇大于阿立哌唑,氟哌啶醇大于齐拉西酮,齐拉西酮大于安慰剂, 阿立哌唑低于安慰剂;震颤方面,氟哌啶醇大于阿立哌唑、利培酮、齐拉西酮,利培酮大于喹硫平,阿立 哌唑低于安慰剂;肌肉僵直方面,氟哌啶醇大于安慰剂;静坐不能方面,氟哌啶醇大于阿立哌唑、奥氮平、 利培酮,奥氮平大于氯氮平,齐拉西酮大于安慰剂,阿立哌唑低于安慰剂。结论 抗精神病药物在神经 系统方面的不良反应主要是帕金森症、锥体外系反应、震颤、僵直和静坐不能。阿立哌唑引起运动类不 良反应的事件少,统计结果小于安慰剂;氟哌啶醇引起的运动类不良反应事件较多,高于大多数非典型 抗精神病药物。说明典型抗精神病药物与非典型抗精神病药物相比更容易导致运动类不良反应。
关键词:  抗精神病药物  运动系统  不良反应  系统评价
DOI:10.3969/j.issn.1009-6574.2018.01.008
基金项目:无锡市医院管理中心2015 年度医学科研重点研究项目(YGZXZ1507)
Adverse events of motor system induced by antipsychotics: a Meta-analysis
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Abstract:
Objective To systematically evaluate antipsychotic-induced motor system adverse reactions in the treatment of psychiatric patients. Methods We searched PubMed, the Cochrane library, CBM, CNKI, VIP and Wan Fang database, collecting randomized controlled trials( RCT) of various antipsychotic drugs compared with placebo or other psychotropic drugs in comparison to the treatment of psychotic disease. The search period was from the reservoir to November 2017. Evaluating the quality of the study according to Cochrane systematic reviews, Metaanalysis was performed for the results of homogeneous studies by The Cochrane Collaboration's software RevMan 5.3 and the heterogeneous data conducted a descriptive qualitative analysis. Results A total of 81 RCTs involving 21 810 patients were included in the analysis. Considering about the frequency of motor system adverse reactions, on the Parkinson syndrome, risperidone was more than quetiapine; on the extrapyramidal system( EPS), olanzapine and haloperidol caused more than aripiprazole, haloperidol caused more than ziprasidone, and ziprasidone caused more than placebo, but the placebo was more than aripiprazole; on the tremor, haloperidol was more than the aripiprazole, risperidone and ziprasidone, risperidone is more than quetiapine and the placebo was more than aripiprazole; haloperidol caused more rigidity than placebo; on the akathisia, haloperidol caused more than aripiprazole, olanzapine and risperidone, olanzapine was more than clozapine, ziprasidone was more than placebo and aripiprazole was lower than placebo. Conclusions The adverse effects of antipsychotics on the motor system are mainly Parkinson, EPS, tremor, rigidity and akathisia. The adverse events of motor system caused by aripiprazole are few, with less statistical significance than placebo. Haloperidol caused more motor-related adverse events, higher than most atypical antipsychotics, which indicates typical antipsychotics are more likely to cause motor side effects than atypical antipsychotics.
Key words:  Antipsychotic drugs  Motor system  Adverse reaction  Systematic review

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