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中华临床医师杂志(电子版) ›› 2017, Vol. 11 ›› Issue (16) : 2134 -2139. doi: 10.3877/cma.j.issn.1674-0785.2017.16.006

所属专题： 文献；

循证医学

选择性5羟色胺抑制剂减轻中风后残障评分的荟萃分析
张志滨1, 曹丽2, 孙静锋3, 谢志海4,†()   
  1. 1. 510430　广州市民政局精神病院精神科
    2. 510500　广州市天河区慢性病防治中心慢病科
    3. 211166　南京，南京医科大学第三附属医院普外科
    4. 528226　佛山市南海经济开发区人民医院内科
  • 收稿日期:2017-03-14 出版日期:2017-08-15
  • 通信作者: 谢志海

Selective serotonin reuptake inhibitors reduce Rankin scores in stroke patients: a Meta-analysis

Zhibin Zhang1, Li Cao2, Jingfeng Sun3, Zhihai Xie4,†()   

  1. 1. Psychiatric Hospital of the Civil Affairs Bureau of Guanzhou, Guangzhou 510430, China
    2. Chronic Disease Control and Prevention Center of Tianhe, Guangzhou 510500, China
    3. Department of General Surgery, the 3rd Hospital Affiliated to Nanjing Medical University, Nanjing 211166, China
    4. Department of Internal Medicine, the Economic Development Zone People’s Hospital of Nanhai, Foshan 528226, China
  • Received:2017-03-14 Published:2017-08-15
  • Corresponding author: Zhihai Xie
  • About author:
    Corresponding author: Xie Zhihai, Email:
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张志滨, 曹丽, 孙静锋, 谢志海. 选择性5羟色胺抑制剂减轻中风后残障评分的荟萃分析[J]. 中华临床医师杂志(电子版), 2017, 11(16): 2134-2139.

Zhibin Zhang, Li Cao, Jingfeng Sun, Zhihai Xie. Selective serotonin reuptake inhibitors reduce Rankin scores in stroke patients: a Meta-analysis[J]. Chinese Journal of Clinicians(Electronic Edition), 2017, 11(16): 2134-2139.

目的

分析选择性5羟色胺摄取抑制剂对减轻中风患者残障程度的作用。

方法

检索Medline、PubMed、Embase、Wos 1990至2015年相关文献，Jadad评分评估所涉及研究的质量，剔除评分<4分的研究，研究分2组，试验组为使用5羟色胺摄取抑制剂的中风患者，对照组为不使用5羟色胺摄取抑制剂的中风患者，2组患者初次中风90 d时使用Rankin量表评估残障分值；分析选择性5羟色胺摄取抑制剂对中风患者的获益程度。

结果

相对于中风患者不使用选择性5羟色胺摄取抑制剂，使用者中风患者总评分标准化均数差（SMD）=0.75，95% CI：0.64~0.87，Z=12.67，P=0.000；（1）氟西汀使用者SMD=0.44，95% CI：0.20~0.68，Z=3.55，P=0.000；（2）帕罗西汀使用者分SMD=0.82，95% CI：0.56~1.08，Z=6.20，P=0.000；（3）舍曲林使用者SMD=0.69，95% CI：0.44~0.94，Z=5.42，P=0.00；（4）西酞普兰使用者SMD=0.91，95% CI：0.64~1.17，Z=6.72，P=0.000；（5）艾司西酞普兰使用者SMD=1.05，95% CI：0.75~1.36，Z=6.78，P=0.000。

结论

选择性5羟色胺摄取抑制剂能明显减轻中风患者残障程度。

关键词: 选择性5羟色胺摄取抑制剂, 氟西汀, 帕罗西汀, 曲舍林, 西酞普兰, 艾司西酞普
Objective

To evaluate whether selective serotonin reuptake inhibitors reduce Rankin scores in stroke patients.

Methods

Related articles published between 1990 and 2015 were searched in MEDLINE, PUBMED, EMBASE, and WOS. The quality of the included studies was evaluated using the Jadad score. Studies with a Jadad score < 4 were included. The patients were divided into two groups: patients who used selective serotonin reuptake inhibitors and those who did not use. Rankin scores were calculated using the modified Rankin scale at 90 days after stroke.

Results

Compared to stroke patients who did not use selective serotonin uptake inhibitors, patients who used selective serotonin reuptake inhibitors had significantly lower Rankin scores (overall: SMD = 0.75, 95% CI: 0.64-0.87, Z = 12.67, P = 0.000; fluoxetine: SMD = 0.44, 95% CI: 0.20-0.68, Z = 3.55, P = 0.000; paroxetine: SMD = 0.82, 95% CI: 0.56-1.08, Z = 6.20, P = 0.000; sertraline: SMD = 0.69, 95% CI: 0.44-0.94, Z = 5.42, P = 0.00; citalopram: SMD = 0.91, 95% CI: 0.64-1.17, Z = 6.72, P = 0.000; escitalopram: SMD = 1.05, 95% CI: 0.75-1.36, Z = 6.78, P = 0.000).

Conclusions

Selective serotonin reuptake inhibitors can reduce rankin scores in stroke patients.

Key words: Selective serotonin inhibitors, Reuptake, Fluoxetine, Paroxetine, Sertraline, Escitalopram
表1 选择性5羟色胺摄取抑制剂对中风作用分析纳入文献表
研究者 年份 M试验组 S试验组 N试验组 M对照组 S对照组 N对照组 药物名 JAD评分
Dam等[3] 1996 61.9 13 16 54.1 21.1 16 弗西汀 5
Robinson等[4] 2000 60.5 10.8 13 63.1 8.2 15 舍曲林 5
? ? 59.2 11.6 14 56.2 7.74 13 艾司西酞普兰 ?
?Wiart?等[5] 2000 87.4 22.8 16 88.7 25.3 15 艾司西酞普兰 5
Chen等[6] 2001 79.31 8.94 19 71.56 9.41 18 弗西汀 5
?Xu?等[7] 2001 73 4.4 26 67 4.1 27 西酞普兰 5
Chen等[8] 2002 61 12.2 24 51.5 10.3 20 帕罗西汀 5
Cheng等[9] 2003 26.38 14.2 25 29.15 17.38 32 弗西汀 5
Wang[10] 2003 75 4.2 51 61 6.9 47 艾司西酞普兰 5
Zhou等[11] 2003 27.8 7.1 28 32.5 7.8 26 舍曲林 5
Liu等[12] 2004 70.3 10.74 30 64.33 7.7 30 艾司西酞普兰 5
Ye等[13] 2004 78.75 14.19 30 50.26 13.4 30 帕罗西汀 5
Chen等[14] 2005 65.76 5.92 40 51.6 7.32 38 帕罗西汀 5
He等[15] 2005 84.26 8.41 27 78.33 15.01 27 帕罗西汀 5
?Xie?等[16] 2005 88.7 7.9 65 79.8 4.5 65 舍曲林 5
Li等[17] 2006 64.36 8.23 50 59.17 9.02 49 西酞普兰 5
Liu等[18] 2006 64.4 12.2 30 35.4 9.1 30 西酞普兰 5
?Xu?等[19] 2006 27.63 4.81 28 32.81 4.13 29 帕罗西汀 5
Kong等[20] 2007 60.4 12.5 37 52.3 13.5 36 弗西汀 5
?Xu?等[21] 2007 64.4 8.23 36 56.9 0.68 36 舍曲林 5
Li等[22] 2008 40.8 3.7 58 38.4 5.8 28 弗西汀 5
?Acler?等[23] 2009 10 82 28 10 75 25 西酞普兰 5
图1 选择性5羟色胺抑制剂对中风的作用分析
图2 氟西汀、帕罗西汀对中风的作用分析
图3 曲舍林、西酞普兰、艾司西酞普兰对中风的作用
图4 选择性5羟色胺摄取抑制剂对中风的作用纳入研究的漏斗图
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