惊恐障碍急性期药物治疗和认知行为治疗及两者联合治疗疗效比较的网络Meta分析  

Efficacy comparison of cognitive behavior therapy,pharmacotherapy,and their combination for acute panic disorder:a network Meta-analysis

作　　者：高凤洁 贺海蓉 陈策[1] 陈云春 高成阁[1] 朱峰[3] 王崴[1] 马现仓[1] Gao Fengjie;He Hairong;Chen Ce;Chen Yunchun;Gao Chengge;Zhu Feng;Wang Wei;Ma Xiancang(Department of Psychiatry,the First Affiliated Hospital of Xiran jiaotong University,Xi'an 710000,China;Clinical Research Center,the First Affiliated Hospital of Xi'an Jiaotong University,Xiran 710000,China;Center for Translational Medicine,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710000,China)

机构地区：[1]西安交通大学第一附属医院精神科,710000 [2]西安交通大学第一附属医院临床研究中心,710000 [3]西安交通大学第一附属医院转化医学中心,710000

出　　处：《中华精神科杂志》2021年第6期461-475,共15页Chinese Journal of Psychiatry

基　　金：国家自然科学基金(81771471)。

摘　　要：目的评价和比较惊恐障碍急性期药物治疗、认知行为治疗(cognitive behavior therapy,CBT)及CBT联合药物治疗的疗效、可接受性和耐受性。方法检索PubMed、Web of Science、Embase、Cochrane Library、中国知网和万方数据库,获取从建库至2021年3月24日发表的有关惊恐障碍急性期药物治疗、CBT及CBT联合药物治疗的随机对照试验,治疗时间为1~6个月,结局指标包括缓解率、有效率、可接受性和耐受性。采用网络Meta分析随机效应模型估计CBT、CBT联合药物、选择性5-羟色胺再摄取抑制剂(selective serotonin-reuptake inhibitors,SSRIs)、5-羟色胺去甲肾上腺素再摄取抑制剂(serotonin-noradrenaline-reuptake inhibitors,SNRIs)、三环类抗抑郁药(tricyclic antidepressants,TCAs)、单胺氧化酶抑制剂(monoamine oxidase inhibitors,MAOI)、苯二氮䓬类药(benzodiazepines,BZD)、去甲肾上腺素能再摄取抑制剂(noradrenergic-teuptake inhibitors,NRI)、其他药物的4个结局指标的相对危险度(relative risk,RR),采用Review Manager对文章进行质量评价,采用R软件的gemtc包进行数据分析,采用GRADEPro对证据等级进行评估。结果检索发现7173篇文献,72篇符合纳入排除条件,共12293例患者。缓解率和有效率均比安慰剂高的治疗措施包括CBT+药物(RR:2.4,95%CI:1.7~3.5)、CBT(RR:1.8,95%CI:1.4~2.3)、SNRIs(RR:1.8,95%CI:1.5~2.2)、BZD(RR:1.6,95%CI:1.4~1.9)、SSRIs(RR:1.5,95%CI:1.4~1.7)、TCAs(RR:1.5,95%CI:1.4~1.8)(括号中为缓解率结果);其中CBT联合药物治疗优于SSRIs、SNRIs和TCAs,BZD的可接受性较好但耐受性较差,SSRIs和TCAs的耐受性较差。结论CBT联合药物治疗比CBT、BZD及常用抗抑郁药SSRIs、SNRIs有效,可能成为治疗惊恐障碍的一线治疗措施。Object This study aims to compare the efficacy,acceptability and tolerability of cognitive behavior therapy(CBT),pharmacotherapy,and their combination therapy for acute panic disorder via network Meta-analysis.Methods Electronic databases including PubMed,Web of Science,Embase,Cochrane Library,CNKI,and Wanfang Data were searched for relevant randomized controlled clinical trials from their inception up to March 24,2021.The outcomes were efficacy(remission rate and response rate),acceptability and tolerability.Network Meta-analysis was adopted with random effects,and estimated relative risk(RR)for all effects of CBT,CBT plus medications,selective serotonin-reuptake inhibitors(SSRIs),serotonin-noradrenaline-reuptake inhibitors(SNRIs),tricyclic antidepressants(TCAs),monoamine oxidase inhibitors(MAOI),benzodiazepines(BZD),noradrenergic-reuptake inhibitors(NRI),and others.This study used gemtc package in R for network analysis,Review Manager for quality assessment,and GRADEPro for evidence assessment,respectively.Results Identified citations(7173)included 72 trials comprising 12293 patients.The treatment measures with higher remission rate and response rate than placebo included CBT+drug(RR:2.4,95%CI:1.7-3.5),CBT(RR:1.8,95%CI:1.4-2.3),SNRI(RR:1.8,95%CI:1.5-2.2),BZD(RR:1.6,95%CI:1.4-1.9),SSRI(RR:1.5,95%CI:1.4-1.7),TCA(RR:1.5,95%CI:1.4-1.8)(remission rate in brackets);Among them,CBT combined with medications was better than SSRI,SNRI and TCA.The acceptability of BZD was better than placebo but its tolerability was inferior.Besides,the tolerability of SSRI and TCA was inferior to placebo.Conclusions CBT combined with medications is more effective than BZD alone and the antidepressants alone.CBT combined with medications may selected the first-line treatment for panic disorder.

关 键 词：惊恐病 认知疗法 药物疗法 META分析 

分 类 号：R749.7[医药卫生—神经病学与精神病学]