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米氮平与氟西汀治疗成人抑郁症疗效及安全性的Meta分析

The Efficacy and Safety of Mirtazapine and Fluoxetine for Depression:A Meta-analysis

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【作者】 周冉徐维平王莉徐婷娟胡世莲严光魏伟李幼平

【Author】 ZHOU Ran1,XU Wei-ping1,WANG Li2,XU Ting-juan1,HU Shi-lian1,YAN Guang1,WEI Wei3,LI You-ping2 1.Anhui Medical University Provincial Hospital,Hefei 230001,China;2.West China Hospital of Sichuan University,Chinese Evidence-Based Medicine/Cochrane Centre,Chengdu 610041,China;3.Institute of Clinical Pharmacology of Anhui Medical University,Hefei 230032,China

【机构】 安徽医科大学附属安徽省立医院四川大学华西医院中国循证医学中心安徽医科大学临床药理研究所

【摘要】 目的系统评价米氮平与氟西汀比较治疗成人抑郁症的疗效及不良反应。方法计算机检索Cochrane Library(2009年第2期)、MEDLINE(1980~2008年12月)、EMbase(1980~2008年12月)、CBM(1980~2008年12月)、VIP(1980~2008年12月)、CNKI(1980~2008年12月)、万方数据库(1980~2008年12月),纳入米氮平与氟西汀比较治疗成年抑郁症的随机对照试验(RCT),对纳入RCT进行质量评价,采用RevMan5.0软件进行Meta分析。结果共纳入5个RCT,包括695例抑郁症患者。Meta分析结果显示:①治疗后1周和2周米氮平组的有效性均显著高于氟西汀组[1周:RR=2.00,95%CI(1.30,3.10),P=0.002;2周:RR=1.49,95%CI(1.08,2.06),P=0.02];但治疗6周后米氮平组与氟西汀组的有效性差异无统计学意义[RR=1.21,95%CI(0.89,1.63),P=0.23];第6周治愈率米氮平组略高于氟西汀组[RR=1.40,95%CI(1.09,1.80),P=0.009]。②不良反应:米氮平组的嗜睡、体重增加发生率高于氟西汀组[RR=1.78,95%CI(1.18,2.70),P=0.006;RR=5.91,95%CI(2.21,15.83),P=0.0004],恶心、失眠发生率低于氟西汀组[RR=0.47,95%CI(0.31,0.71),P=0.0003;RR=0.39,95%CI(0.17,0.89),P=0.03],其余常见不良反应差异无统计学意义(P>0.05)。结论米氮平抗抑郁疗效优于氟西汀且起效较快,在常见不良反应中,米氮平更易引起嗜睡及体重增加,氟西汀更易引起恶心及失眠,其余不良反应两组差异无统计学意义。

【Abstract】 Objective To assess the efficacy and safety of mirtazapine and uoxetine on depression.Methods We searched The Cochrane Library(Issue 2,2009),MEDLINE(1980 to Dec.2008),EMbase(1980 to Dec.2008),CBM(1980 to Dec.2008),VIP(1980 to Dec.2008),CNKI(1980 to Dec.2008) and Wanfang database(1980 to Dec.2008) to search randomized controlled trials(RCTs) comparing mirtazapine with uoxetine for depression.The quality of the included trials was assessed and meta-analysis was conducted by RevMan 5.0 software.Results Five RCTs involving 695 patients were included.The results of meta-analyses showed that:(1) After one-week treatment and two-week treatment,e ectiveness of the mirtazapine group was significantly higher than that of the uoxetine group [one-week treatment:RR=2.00,95%CI(1.30,3.10),P=0.002;two-week treatment:RR=1.49,95%CI(1.08,2.06),P=0.02].But after six-week treatment,there was no significant difference of the efficacy between the mirtazapine and the uoxetine groups with RR=1.21 and 95%CI 0.89 to 1.63(P=0.23),and the cure rate of the mirtazapine group was a little higher than that of the uoxetine group with RR=1.40 and 95%CI 1.09 to 1.80(P=0.009).(2) Side reaction:The somnolence and weight gain rates of the mirtazapine group was higher than those of the uoxetine group with RR=1.78 and 95%CI 1.18 to 2.70(P=0.006) and RR=5.91 and 95%CI 2.21 to 15.83(P=0.000 4).But fluoxetine more easily induced nausea and insomnia with RR=0.47 and 95%CI 0.31 to 0.71(P=0.000 3);RR=0.39 and 95%CI 0.17 to 0.89(P=0.03) than mirtazapine.And the other common side reactions were all not significantly di erent between the two groups(P>0.05).Conclusion Mirtazapine is more e ective than uoxetine and works faster.Mirtazapine could more easily induce somnolence and weight gain,and is with lower nausea or insomnia rate when compared with uoxetine.And there is no significant difference in comparison of other common side reactions.

【关键词】 米氮平; 氟西汀; 抑郁症; Meta分析;

【Key words】 Mirtazapine; Fluoxetine; Depression; Meta-analysis;

【分类号】R971.43;R181.2;R749.42;

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