药物治疗儿童抽动障碍的系统评价再评价  

Overview of the Systematic Review of Drug Treatment for Tic Disorders in Children

作　　者：张建华 康冰瑶[1,2] 李丹 罗丹[1,2] 杨春松 陈静[2,4] ZHANG Jianhua;KANG Bingyao;LI Dan;LUO Dan;YANG Chunsong;CHEN Jing(Nursing Unit of Pediatric Outpatient,West China Second Hospital,Sichuan University,Chengdu 610041,China;Key Laboratory of Birth Defects and Related Diseases of Women and Children,Sichuan University,Ministry of Education,Chengdu 610041,China;Dept,of Pharmacy/Evidence-based Pharmacy Center,West China Second Hospital,Sichuan University,Chengdu 610041,China;Dept,of Pediatric Gastroenterology,West China Second Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西第二医院儿科门诊护理单元,成都610041 [2]四川大学出生缺陷与相关妇儿疾病教育部重点实验室,成都610041 [3]四川大学华西第二医院药学部/循证药学中心,成都610041 [4]四川大学华西第二医院小儿消化科,成都610041

出　　处：《中国药房》2021年第21期2647-2654,共8页China Pharmacy

基　　金：国家卫健委卫生技术评估重点实验室开放基金资助项目(No.00402154A8002)。

摘　　要：目的:汇总分析药物治疗儿童抽动障碍的系统评价研究证据,为临床实践提供循证参考。方法:计算机检索Medline、Embase、中国生物医学文献数据库、中国知网、维普中文科技期刊数据库、万方数据知识服务平台等数据库,纳入药物治疗儿童抽动障碍有效性和安全性的系统评价研究,运用AMSTAR-2质量评价工具对纳入的系统评价进行质量评价,并提取药物治疗的干预措施、诊断标准、结局指标、纳入研究类型、主要结论、对照措施、效应量值等,对结果进行描述性分析。结果:共纳入27项系统评价,其中5项为中等质量研究,8项为低质量研究,14项为极低质量研究。Meta分析显示,典型抗精神病药物能控制抽动症状,但不良反应较突出,安全性欠佳;非典型抗精神病药物中的利培酮和阿立哌唑治疗抽动障碍的有效性和安全性均较好,且研究证据较充足;α2肾上腺素能激动剂可乐定能有效控制抽动症状,且不良反应较少,特别是针对抽动障碍合并注意缺陷多动障碍(ADHD)患者的有效性和安全性俱佳,研究证据较充足;硫必利能有效改善抽动症状,整体耐受性尚可;托莫西汀和哌甲酯能显著改善抽动障碍合并ADHD患者的抽动症状。结论:在儿童抽动障碍的临床治疗中,典型抗精神病药物不良反应较突出,安全性欠佳;利培酮、阿立哌唑、可乐定和硫必利有效性和安全性均较好;可乐定、托莫西汀和哌甲酯能显著改善抽动障碍合并ADHD患者的抽动症状,但托莫西汀和哌甲酯的系统评价方法学质量欠佳,有待进一步改进。OBJECTIVE:To overview and analyze the current evidence of systematic reviews of drug treatment for children with tic disorder(TD),and to provide evidence-based reference for clinical practice.METHODS:Retrieved from Medline,Embase,CBM,CNKI,VIP and Wanfang database,and so on,systematic reviews about the efficacy and safety of drug treatment for TD were collected.AMSTAR-2 tools were used to evaluate the quality of included studies;the intervention measures,diagnosis standard,outcome index,the types of included studies,main conclusion,control measures,effect sizes of different drug treatment were also extracted and analyzed descriptively.RESULTS:A total of 27 systematic reviews were included,of which 5 were medium-quality,8 low-quality and 14 very-low-quality.Meta-analysis showed that although typical psychiatric drugs could control tic symptoms,ADR were prominent and the safety was not good;risperidone and aripiprazole as atypical psychiatric drugs had good efficacy and safety,and the research evidence was relatively sufficient.Clonidine asα2 adrenergic agonist could effectively control tic symptoms with fewer ADR,especially for patients with affention deficit and hyperactivity disorder(ADHD),and research evidence was sufficient.Tiapride could effectively improve tic symptoms,and the overall tolerance was better.Tomoxetine and methylphenidate could significantly improve the tic symptoms of tic patients with ADHD.CONCLUSIONS:In the clinical treatment of TD in children,ADR induced by typical antipsychotics are prominent and the safety is not good;risperidone,aripiprazole,clonidine and tiapride have good efficacy and safety.Clonidine,tomoxetine and methylphenidate could significantly improve tic symptoms of TD patients with ADHD.But the quality of systematic review methodology for tomoxetine and methylp-henidate is not good and further improvement is needed.

关 键 词：抽动障碍 药物治疗 系统评价 儿童 有效性 安全性 

分 类 号：R179[医药卫生—妇幼卫生保健] R985[医药卫生—公共卫生与预防医学]