奥氮平联用氟西汀治疗精神分裂症阴性症状的疗效及安全性meta分析  

The efficacy and safety of olanzapine combined with fluoxetine in the treatment of negative symptoms of schizophrenia:a systematic review

作　　者：王少华[1] 周惠至 杨晨[1] 杨润许 孙宁 韩冬 张琨[1] 陈诗 孙黎[2] 康传媛[1] WANG Shaohua;ZHOU Huizhi;YANG Chen;YANG Runxu;SUN Ning;HAN Dong;ZHANG Kun;CHEN Shi;SUN Li;KANG Chuanyuan(Department of Psychiatry,the First Affilidted Hospital of Kunming Medical University, Kunming 650032, Chin)

机构地区：[1]昆明医科大学第一附属医院精神科,昆明650032 [2]国家精神心理疾病临床医学研究中心(北京大学第六医院)儿童研究室

出　　处：《中国神经精神疾病杂志》2018年第2期104-109,共6页Chinese Journal of Nervous and Mental Diseases

基　　金：国家自然科学基金(编号:81460218;30900488);国家科技支撑计划项目(编号:2015BAI13B01)

摘　　要：目的通过meta分析系统评价奥氮平联用氟西汀治疗精神分裂症患者阴性症状的疗效及其安全性。方法检索Pubmed、Medline、Web of science、EMBASE、Cochrane Library、CNKI、万方数据库在1990年1月至2017年5月公开发表的关于奥氮平联用氟西汀治疗精神分裂症的中英文文献,提取奥氮平联用氟西汀组与奥氮平组阴性症状、阳性症状及TESS量表副作用的数据,采用Review Manager 5.3软件进行文献质量评估,并按照Cochrane系统评价员学习手册进行meta分析。结果共纳入5项研究,其中中文3项,英文2项。Meta分析结果提示,奥氮平联用氟西汀治疗精神分裂症患者的阴性症状效果与单用奥氮平无统计学差异(标准化均数差(standradized mean difference,SMD)=-0.61,95%CI:-1.30~0.08,P=0.08)。因国内外研究患者纳入标准有差异,异质性较大(I2=83%),故对国内外研究进行亚组分析:仅国内研究显示奥氮平联用氟西汀治疗以阴性症状为主精神分裂症患者的阴性症状更具优势(SMD=-1.19,95%CI:-1.52^-0.86,P<0.01),并且奥氮平联用氟西汀治疗所致体质量增加的风险低于单用奥氮平(SMD=0.28,95%CI:0.13~0.57,P<0.01)。结论仅国内研究初步提示奥氮平联用氟西汀较单用奥氮平治疗以阴性症状为主精神分裂症患者的阴性症状疗效更佳,并且体质量增加的风险更低。Objective To undertake a systematic review to evaluate the efficacy and safety of olanzapine combined with fluoxetine in the treatment of negative symptoms of schizophrenia. Methods Articles published before May 31, 2017 were identified by searching the Pub Med, Medline,Web of science excerpta medica database（EMBASE）,Cochrane Library,China national knowledge infrastructure（CNKI）, Wan Fang data, using the key words fluoxetine,olanzapine, schizophren＊ and schizophrenia. Statistical analysis were conducted by Review Manager 5.3 software according to Cochrane Handbook for meta analysis. Result A total of 5 randomized, controlled studies were included（3 Chinese and 2 English）. Meta analysis showed that the efficacy of olanzapine combined with fluoxetine（combination group） in the treatment of the negative symptoms in schizophrenia was not significant difference from olanzapine alone（standradization of mean difference（SMD）=-0.61, 95% CI：-1.30-0.08, P=0.08）. Due to the high heterogeneity of the five studies（I2=83% 75%）, Subgroup analysis which was conducted in three domestic research revealed that combinationgroup exhibited a better efficacy in the treatment of negative symptoms in negative symptoms predominant schizophrenia（defined as score of PANSS negative subscale 30）（SMD =-1.19, 95% CI：-1.52 --0.86, P 0.01） and a lower risk to develop weight gain（SMD=0.28, 95% CI：0.13-0.57, P0.01）. Conclusion Domestic studies have provided the initial evidence that olanzapine in combination with fluoxetine is more effective and has a lower risk of weight gain than olanzapine alone in the treatment of negative symptoms for schizophrenics..

关 键 词：精神分裂症 奥氮平 氟西汀 阴性症状 META分析 

分 类 号：R749.3[医药卫生—神经病学与精神病学]