抗抑郁药物治疗儿童青少年抑郁症疗效和耐受性的网状meta分析  

Efficacy and tolerability of antidepressant drugs in treatment of depression in children and adolescents:a network meta-analysis

作　　者：饶燕晓 杨荣旺[1] 赵京 曹庆久[3] RAO Yanxiao;YANG Rongwang;ZHAO Jing;CAO Qingjiu(Department of Psychology,Children’s Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,National Regional Medical Center for Children,Hangzhou 310052,China;The Fourth Department of Brain Medicine,the 984th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army,Beijing 100094,China;Institute of Mental Health,Peking University,Beijing 100083,China)

机构地区：[1]浙江大学医学院附属儿童医院心理科国家儿童健康与疾病临床医疗研究中心国家儿童区域医疗中心,浙江杭州310052 [2]中国人民解放军联勤保障部队第九八四医院脑四科,北京100094 [3]北京大学精神卫生研究所,北京100083

出　　处：《浙江大学学报（医学版）》2022年第4期480-490,共11页Journal of Zhejiang University(Medical Sciences)

基　　金：国家自然科学基金(81973060)。

摘　　要：目的:比较多种抗抑郁药治疗儿童青少年抑郁症的效果,为儿童青少年抑郁症的治疗提供疗效与耐受性方面的依据。方法:在PubMed、Cochrane Library、EMBASE、Web of Science、PsycINFO、中国生物医学文献数据库、中国知网和万方数据知识服务平台等数据库中检索关于抗抑郁药治疗儿童青少年抑郁症的随机对照试验,检索时间截至2021年12月。对纳入文献进行质量评价及数据提取,采用Stata 15.1软件对有效率、耐受性进行分析,采用累积排序概率曲线下面积(SUCAR)评估药物有效率和耐受性的累积概率。结果:最终纳入32篇文献的33项随机对照试验研究,共6949例患者,涉及阿米替林、维拉唑酮、氟西汀、司来吉兰、帕罗西汀、丙咪嗪、地昔帕明、舍曲林、去甲替林、艾司西酞普兰、西酞普兰、文拉法辛、度洛西汀等13种抗抑郁药。网状meta分析结果显示,度洛西汀(OR=1.95,95%CI:1.41~2.69)、氟西汀(OR=1.73,95%CI:1.40~2.14)、文拉法辛(OR=1.37,95%CI:1.04~1.80)、艾司西酞普兰(OR=1.48,95%CI:1.12~1.95)的有效率显著高于安慰剂(均P<0.05),网状meta的累积概率排序为度洛西汀(87.0%)、阿米替林(83.3%)、氟西汀(79.0%)、艾司西酞普兰(62.7%)等。丙咪嗪(OR=0.15,95%CI:0.08~0.27)、舍曲林(OR=0.33,95%CI:0.16~0.71)、文拉法辛(OR=0.35,95%CI:0.17~0.72)、度洛西汀(OR=0.35,95%CI:0.17~0.73)、帕罗西汀(OR=0.52,95%CI:0.30~0.88)的不耐受发生率显著高于安慰剂(均P<0.05),网状meta的累积概率排序为丙咪嗪(95.7%)、舍曲林(69.6%)、文拉法辛(68.6%)、度洛西汀(68.2%)等。结论:在13种抗抑郁药中,度洛西汀、氟西汀、艾司西酞普兰和文拉法辛治疗儿童青少年抑郁症的效果优于安慰剂,但度洛西汀和文拉法辛的耐受性较差。Objective:To evaluate the efficacy and safety of antidepressants in treatment of depression disorder in children and adolescents by network meta-analysis.Methods:Databases of PubMed,Cochrane Library,EMBASE,Web of Science,PsycINFO,CBM,CNKI and Wanfang Data were searched for randomized controlled trials(RCT)related to antidepressants in treatment of children and adolescents with depression from inception to December 2021.Quality assessment and data extraction from the included RCTs were performed.Statistical analyses of efficacy and tolerability were conducted with Stata 15.1 software.Surface under the cumulative ranking(SUCAR)was used to rank the value of the antidepressants.Results:A total of 33 RCTs were included in 32 articles,involving 6949 patients.There are 13 antidepressants used in total,including amitriptyline,vilazodone,fluoxetine,selegiline,paroxetine,imipramine,desipramine,sertraline,nortriptyline,escitalopram,citalopram,venlafaxine and duloxetine.The results of network meta-analysis showed that the efficacy of duloxetine(OR=1.95,95%CI:1.41–2.69),fluoxetine(OR=1.73,95%CI:1.40–2.14),venlafaxine(OR=1.37,95%CI:1.04–1.80)and escitalopram(OR=1.48,95%CI:1.12–1.95)were significantly higher than that of placebos(allP<0.05);the probability cumulative ranks were duloxetine(87.0%),amitriptyline(83.3%),fluoxetine(79.0%),escitalopram(62.7%),etc.The results showed that the intolerability of patients receiving imipramine(OR=0.15,95%CI:0.08–0.27),sertraline(OR=0.33,95%CI:0.16–0.71),venlafaxine(OR=0.35,95%CI:0.17–0.72),duloxetine(OR=0.35,95%CI:0.17–0.73)and paroxetine(OR=0.52,95%CI:0.30–0.88)were significantly higher than that of placebos(allP<0.05),and the probability cumulative ranks were imipramine(95.7%),sertraline(69.6%),venlafaxine(68.6%),duloxetine(68.2%),etc.Conclusion:Among 13 antidepressants,duloxetine,fluoxetine,escitalopram and venlafaxine are significantly better than placebo in terms of efficacy,but duloxetine and venlafaxine are less well tolerated.

关 键 词：儿童 青少年 抑郁症 抗抑郁药 疗效 耐受性 META分析 

分 类 号：R749[医药卫生—神经病学与精神病学]