李艷 巴文強(qiáng) 袁也豐
[摘要]目的 采用Meta分析方法比較帕利哌酮緩釋片與阿立哌唑治療精神分裂癥的效果及不良反應(yīng)。方法 計(jì)算機(jī)檢索中國知網(wǎng)、萬方、維普、中國生物醫(yī)學(xué)文獻(xiàn)服務(wù)系統(tǒng)、PubMed、Embase、Cochrane Library數(shù)據(jù)庫,收集帕利哌酮緩釋片與阿立哌唑治療精神分裂癥的隨機(jī)對(duì)照試驗(yàn)(RCTs)。檢索時(shí)間為建庫至2019年10月。使用RevMan 5.3軟件進(jìn)行Meta分析。結(jié)果 最終共納入22篇RCTs文獻(xiàn)。Meta分析顯示,治療第2周末和第4周末帕利哌酮緩釋片組患者的陽性和陰性癥狀量表(PANSS)總分減分情況優(yōu)于阿立哌唑組,差異有統(tǒng)計(jì)學(xué)意義[第2周末:MD=-8.43,95%CI(-14.61,-2.26),P=0.007;第4周末:MD=-5.23,95%CI(-9.57,-0.89),P=0.02]。治療第8周末,兩組患者的PANSS總分[MD=-5.47,95%CI(-11.31,-0.38),P=0.07]、陽性癥狀評(píng)分[MD=-2.49,95%CI(-7.33,2.34),P=0.31]、一般精神病理癥狀評(píng)分[MD=-1.43,95%CI(-5.99,3.12),P=0.54]比較,差異無統(tǒng)計(jì)學(xué)意義;帕利哌酮緩釋片組患者的陰性癥狀評(píng)分減分情況優(yōu)于阿立哌唑組,差異有統(tǒng)計(jì)學(xué)意義[MD=-1.18,95%CI(-2.10,-0.26),P=0.01];帕利哌酮緩釋片組患者的催乳素水平高于阿立哌唑組,差異有統(tǒng)計(jì)學(xué)意義[MD=31.39,95%CI(13.62,49.15),P=0.0005]。兩組患者的不良反應(yīng)發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。結(jié)論 帕利哌酮緩釋片治療精神分裂癥的效果與阿立哌唑相似,但起效更快,對(duì)陰性癥狀的改善效果更好。兩者的不良反應(yīng)發(fā)生率相似,但帕利哌酮緩釋片會(huì)升高患者血清催乳素水平。
[關(guān)鍵詞]帕利哌酮緩釋片;阿立哌唑;精神分裂癥;Meta分析
[中圖分類號(hào)] R749 ? ? ? ? ?[文獻(xiàn)標(biāo)識(shí)碼] A ? ? ? ? ?[文章編號(hào)] 1674-4721(2020)8(c)-0027-06
[Abstract] Objective To compare the effect and adverse reactions of Paliperidone Sustained-release Tablets and Aripiprazole in the treatment of schizophrenia by Meta-analysis. Methods Randomized controlled trials (RCTs) related to the Paliperidone Sustained-release Tablets and Aripiprazole in the treatment of patients with schizophrenia were searched in China National Knowledge Infrastructure, Wanfang, Weipu Database, Chinese Biomedical Literature Service System, PubMed, Embase, Cochrane Library databases. Search time was from the establishment of the database to October 2019. Meta-analysis was carried out with RevMan 5.3 software. Results Finally, a total of 22 RCTs literatures were included. Meta-analysis showed that compared with the Aripiprazole group, the reduction of total score of positive and negative symptoms scale (PANSS) in the Paliperidone Sustained-release Tablets group was better after 2 and 4 weeks of treatment, and the differences were statistically significant (after 2 weeks of treatment: MD=-8.43, 95%CI[-14.61, -2.26], P=0.007; after 4 weeks of treatment: MD=-5.23, 95%CI[-9.57,-0.89], P=0.02). After 8 weeks of treatment, there were no significant differences in the PANSS score (MD=-5.47, 95%CI[-11.31, -0.38], P=0.07), positive symptoms score (MD=-2.49, 95%CI[-7.33, 2.34], P=0.31), and the general psychotic symptoms score (MD=-1.43, 95%CI[-5.99, 3.12], P=0.54) between the two groups. Compared with Aripiprazole group, the reduction of negative symptoms score of Paliperidone Sustained-release Tablets group was better, and the difference was statistically significant (MD=-1.18, 95%CI[-2.10, -0.26], P=0.01). The prolactin level in the Paliperidone Sustained-release Tablets group was higher than that in the Aripiprazole group, and the difference was statistically significant (MD=31.39, 95%CI[13.62, 49.15], P=0.0005). There was no significant difference in the incidence of adverse reactions between the two groups of patients (P>0.05). Conclusion Paliperidone Sustained-release Tablets are as effective as Aripiprazole in the treatment of schizophrenia. However, it has faster onset and much better effect for the negative symptoms. The incidence of adverse reactions between the two drugs is similar, but Paliperidone Sustained-release Tablets can increase the serum prolactin level of patients.
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(收稿日期:2020-03-06)