拉莫三嗪添加治疗癫合并抑郁障碍的Meta分析  

Evaluation of the efficacy of adjunctive lamotrigine in the treatment of epilepsy and depression with Meta-analysis

作　　者：曹娟[1] 李岱[2] 郜姗姗 宋毅军[1] 

机构地区：[1]天津医科大学总医院神经内科,300052 [2]天津医科大学总医院保健医疗部,300052

出　　处：《中国现代神经疾病杂志》2016年第1期23-29,共7页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：天津市应用基础与前沿技术研究计划项目(项目编号:14JCZDJC35400);天津市应用基础与前沿技术研究计划项目(项目编号:14JCYBJC28300);天津市滨海新区卫生局科技重点项目(项目编号:2013BWKZ003)~~

摘　　要：目的对拉莫三嗪添加治疗癫合并抑郁障碍的疗效进行系统评价。方法以拉莫三嗪(lamotrigine)、癫痫(epilepsy)、抑郁(depressive)等中英文词汇,计算机检索1998年1月-2014年6月美国国立医学图书馆生物医学信息检索系统、Cochrane临床对照试验中心注册库、中国知网中国知识基础设施工程、万方数据库等关于拉莫三嗪添加治疗癫合并抑郁障碍的临床研究,分别以Cochrane系统评价手册5.0.2随机对照试验质量评价标准和Rev Man 5.1.1统计软件行文献质量评价和Meta分析。结果经剔除重复和不符合纳入标准文献,48篇文献中最终仅纳入3项临床试验共668例癫合并抑郁障碍患者。Meta分析显示:拉莫三嗪组患者Beck抑郁量表第2版(MD=-8.400,95%CI:-10.890^-5.920;P=0.000)、康奈尔精神抑郁量表(MD=-8.240,95%CI:-11.180^-5.290;P=0.000)以及简明心境量表(MD=-24.210,95%CI:-30.740^-17.680;P=0.000)评分改善程度均优于对照组;POMS量表6项分量表评分中拉莫三嗪组患者紧张-焦虑(MD=-3.360,95%CI:-4.620^-2.100;P=0.000)、抑郁-沮丧(MD=-5.490,95%CI:-7.420^-3.560;P=0.000)、愤怒-敌意(MD=-3.870,95%CI:-5.510^-2.230;P=0.000)、疲乏-迟钝(MD=-4.480,95%CI:-5.630^-3.320;P=0.000)、迷惑-混乱(MD=-2.720,95%CI:-3.730^-1.720;P=0.000)评分均低于对照组,而精力-活力评分高于对照组(MD=3.970,95%CI:2.870~5.070;P=0.000)。结论拉莫三嗪添加治疗癫合并抑郁障碍疗效良好,主要不良反应为皮疹、中枢神经系统兴奋等。Objective patients with epilepsy and comorbid depressive symptoms.MethodsRelevant clinical trials weresearched via Pub Med, Cochrane Central Register of Controlled Trials（CENTRAL）, China NationalKnowledge Infrastructure（CNKI） and Wanfang Data from January 1998 to June 2014 using the followingretrieval words： lamotrigine, epilepsy and depressive both in Chinese and English. The Cochrane Handbookfor Systematic Reviews of Interventions（Version 5.0.2） was used to evaluate the quality of randomizedcontrolled trials（RCTs）. Two reviewers independently evaluated the quality of included articles andabstracted the data. Meta-analysis was conducted using Rev Man 5.1.1 software.ResultsAccording to theinclusion criteria, 3 prospective clinical trials with a total of 668 patients were finally selected. The Meta-analysis showed the Beck Depression Inventory-Ⅱ（BDI-Ⅱ） score（MD =- 8.400, 95%CI：- 10.890-- 5.920;P = 0.000）, Cornell Dysthymia Rating Scale（CDRS） score（MD =- 8.240, 95%CI：- 11.180-- 5.290; P =0.000） and Profile of Mood States（POMS） score（MD =- 24.210, 95% CI：- 30.740-- 17.680; P = 0.000） inlamotrigine group were significantly improved compared to those in control group. As for 6 mood states inPOMS, the scores of tension-anxiety（MD =- 3.360, 95%CI：- 4.620-- 2.100; P = 0.000）, depression-dejection（MD =- 5.490, 95%CI：- 7.420-- 3.560; P = 0.000）, anger-hostility（MD =- 3.870, 95%CI：- 5.510-- 2.230; P =0.000）, fatigue-inertia（MD =- 4.480, 95%CI：- 5.630-- 3.320; P = 0.000）, confusion-bewilderment（MD =- 2.720, 95%CI：- 3.730-- 1.720; P = 0.000） in lamotrigine group were all significantly lower than those incontrol group, while the score of vigor- activity（MD = 3.970, 95% CI： 2.870-5.070; P = 0.000） wassignificantly higher than that in control group.ConclusionsThe effect of adjunctive lamotrigine in thetreatment of patients with epilepsy and depression is favorable. The most common side effects include rashand stimulation of central nervous sy

关 键 词：三嗪类 癫 抑郁 META分析 

分 类 号：R742.1[医药卫生—神经病学与精神病学]