认知行为治疗联合药物治疗强迫症疗效的meta分析  

Cognitive behavioral therapy combined with pharmacotherapy for obsessive compulsive disorder: A meta-analysis

作　　者：黄芳芳[1] 李占江[1] 韩海英[1] 熊红芳[1] 马云[1] 

机构地区：[1]首都医科大学附属北京安定医院/临床心理学系,精神疾病诊断与治疗北京市重点实验室,北京100088

出　　处：《中国心理卫生杂志》2013年第9期643-649,共7页Chinese Mental Health Journal

基　　金：国家科技支撑计划课题:神经症早期识别与治疗方案优化研究(2007BAI17B01)

摘　　要：目的:通过对随机对照试验的数据进行meta分析,比较药物联合认知行为治疗(CBT)与单纯药物或CBT治疗对强迫症的疗效,为临床实践提供选择依据。方法:检索PubMed、Embase和Central数据库,收集比较药物联合CBT与单纯药物或CBT治疗强迫症疗效的随机对照试验,选取联合治疗组与单纯治疗组的耶鲁-布朗强迫量表测量数据并采用均差作为效应量,应用RevMan5软件进行meta分析。结果:共纳入7项符合标准的研究,合计样本量468人。排除可能引起异质性的1组数据后,3组数据比较了药物联合CBT与单纯药物治疗的疗效且无异质性(Q=0.48,P>0.1),结果显示联合治疗组对强迫症状的改善优于单纯药物组(MD=6.46,Z=5.03,P≤0.05);7组数据比较了药物治疗联合CBT与单纯CBT的疗效且无异质性(Q=9.08,P>0.1),结果显示联合治疗组与单纯CBT组对强迫症状的改善没有差别(MD=0.87,Z=1.22,P>0.05)。结论:鉴于目前结果,推测对于强迫症状的改善,药物治疗联合CBT优于单纯药物治疗而与单纯CBT相当,但仍需进一步研究证实。Objective：To evaluate the efficacy of pharmacotherapy combined with cognitive behavioral therapy （CBT） in the treatment of obsessive compulsive disorder （OCD） with meta-analysis of data came from randomized controlled trials （RCTs） and to help choose suitable treatment plan in clinic.Methods：The databases of Pubmed,Embase and Central were searched to collect efficacy data of pharmacotherapy combined with CBT versus either alone in RCTs,the mean difference was used as effect size and the measured data of Yale-Brown Obsessive Compulsive Scale （Y-BOCS） were extracted from each study to conduct a meta-analysis with RevMan5.Results：Seven studies were involved in the meta-analysis,including 468 patients with OCD.There was no heterogeneity between 3sets of data which compared the efficacy of combined therapy and pharmacotherapy alone after excluding 1 set of data which possibly caused the heterogeneity （Q =0.48,P ＞ 0.1） and combined therapy was superior to pharmacotherapy alone in improving obsessive compulsive symptom （MD =6.46,Z =5.03,P ≤0.05）.There was no heterogeneity between 7 sets of data which compared the efficacy of combined therapy and CBT alone （Q =9.08,P ＞0.1） and combined therapy was not superior to CBT alone in improving obsessive compulsive symptom （MD =0.87,Z =1.22,P ＞0.05）.Conclusion：It suggests that pharmacotherapy combined with CBT may be superior to pharmacotherapy alone but be comparable to CBT alone in improving obsessive compulsive symptom and further study is necessary.

关 键 词：强迫症 认知行为治疗 药物治疗 随机对照试验 META分析 

分 类 号：R749.79[医药卫生—神经病学与精神病学] R749.059[医药卫生—临床医学]