抗抑郁药与心力衰竭患者死亡率关系的荟萃分析  

The relationship between antidepressant treatment and mortality risk in heart failure patients:a meta-analysis

作　　者：郭宁红[1,2] 刘萧[1] 李帅 洪葵[1,3] 

机构地区：[1]南昌大学第二附属医院心内科,南昌330006 [2]南昌大学第二附属医院血液科 [3]江西省分子医学重点实验室

出　　处：《临床心血管病杂志》2018年第2期142-146,共5页Journal of Clinical Cardiology

摘　　要：目的:心力衰竭(心衰)患者常伴有抑郁症状,选择性5-羟色胺再摄取抑制剂(SSRIs)和三环类(TCAs)是心衰伴抑郁患者最常用的抗抑郁药,但这两类抗抑郁药是否增加心衰死亡率有争议。本研究系统评价心衰患者使用SSRIs和TCAs与死亡率的关系。方法:计算机检索PubMed、Embase和Cochrane图书馆数据库所有关于抗抑郁药与心衰患者死亡率相关性的临床试验,使用ReVMan 5.3软件进行荟萃分析,比较使用抗抑郁药与未使用抗抑郁药两组心衰患者全因和心血管死亡率是否有统计学差异。本研究中的SSRIs包括氟罗西汀、帕罗西汀、舍曲林、西他普仑与依他普仑;TCAs包括去甲替林、阿米替林、丙米嗪与喹硫平。结果:共纳入8篇文章,使用抗抑郁药组较未用抗抑郁药组全因死亡率升高(HR:1.25,95%CI:1.16~1.34,P<0.001),而心血管死亡率两组间无显著差异(HR:0.97,95%CI:0.74~1.26,P=0.80)。亚组分析显示,使用SSRIs(HR:1.26,95%CI:1.20~1.33,P=0.004)或TCAs(HR:1.30,95%CI:1.16~1.46,P=0.01)的心衰患者全因死亡率均明显升高。使用SSRIs(HR:1.01,95%CI:0.82~1.24,P=0.94)或TCAs(HR:1.02,95%CI:0.86~1.21,P=0.85)的心衰患者心血管死亡率较未用抗抑郁药组无明显差异。结论:使用抗抑郁药可能增加心衰患者的全因死亡率,而对心血管死亡率没有影响,提示临床医生必须重新审视抗抑郁药对心衰患者远期预后的影响,合理使用抗抑郁药物。Objective：Selective serotonin reuptake inhibitors（SSRIs）and tricyclics（TCAs）are the most frequently prescribed antidepressant drugs in heart failure（HF）patients with depression.However,the association between antidepressant treatment and long-term mortality in HF remains controversial.In this study,we aimed to quantify this association and to evaluate the effects of SSRIs/TCAs on the long-term prognoses of HF patients.Method：We retrieved data from the PubMed,EMBASE and Cochrane Library Databases（from inception to June 2017）.In this study,the SSRIs included fluoxetine,paroxetine,sertraline,citalopram and escitalopram.The TCAs included nortriptyline,amitriptyline imipramine and dosulepin.Data were extracted from the eligible articles,and we used a random effects model to calculate the effect estimates.Result：Eight studies（2 RCTs and 6 cohort studies）with 125 763 participants were included for all-cause mortality outcomes.Five articles（1 RCT and4 cohort studies）with 120 373 individuals were included for cardiovascular（CV）death outcomes.The pooled HRs of the antidepressants used were 1.25（95%CI：1.16-1.34,P0.001）for all-cause death and 0.97（95%CI：0.74-1.26,P=0.80）for CV death.In the subgroup analysis,SSRI users（HR：1.26,95%CI：1.20-1.33,P=0.004）and TCAs（HR：1.30,95%CI：1.16-1.46,P=0.01）among HF patients were associated with an increased risk in all-cause mortality.Neither SSRIs（HR：1.01,95%CI：0.82-1.24,P=0.94）nor TCAs（HR：1.02,95%CI：0.86-1.21,P=0.85）increased the risk of CV mortality in HF patients.Conclusion：The use of antidepressant in patients with HF is associated with an increased risk for all-cause death but not CV death.These results indicate the importance of further examining the effect of antidepressants on cardiac function and mortality.

关 键 词：心力衰竭 抗抑郁药 5-羟色胺再摄取抑制剂 三环类抗抑郁药 死亡率 

分 类 号：R541.6[医药卫生—心血管疾病]