【摘要】 目的系统评价新一代抗抑郁剂治疗心肌梗死伴抑郁的有效性和安全性。方法计算机检索PubMed、The Cochrane Library、EMbase、Web of Science、CBM、CNKI、WanFang Data和VIP数据库,搜集新一代抗抑郁剂治疗心肌梗死伴抑郁的RCT,检索时限为建库至2017年12月1日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果纳入10个RCT,共552例患者。Meta分析结果显示,相比于对照组,新一代抗抑郁剂可显著改善患者的抑郁症状[SMD=–1.38,95%CI(–1.93,–0.82),P<0.000 01],并降低患者心绞痛[RR=0.42,95%CI(0.25,0.71),P=0.001]、复发心梗[RR=0.43,95%CI(0.22,0.83),P=0.01]及因心脏原因再入院[RR=0.51,95%CI(0.28,0.92),P=0.03]发生率。但两组在全因死亡率[RR=0.45,95%CI(0.18,1.11),P=0.08]、心源性死亡率[RR=0.53,95%CI(0.16,1.73),P=0.29]和心衰发生率[RR=0.75,95%CI(0.39,1.43),P=0.38]方面,差异无统计学意义。亚组分析发现,不同抗抑郁药物的抑郁改善程度具有显著差异(P<0.000 1),西酞普兰和氟西汀可能具有更好的抗抑郁疗效。结论新一代抗抑郁剂可显著改善心梗伴抑郁患者的抑郁症状,降低非致命心脏事件的发生率,但不影响患者的全因死亡率和心源性死亡率。受纳入研究数量和质量所限,上述结论尚待更多高质量研究予以验证。更多还原

【Abstract】 Objectives To evaluate the efficacy and safety of newer-generation antidepressants for patients with myocardial infarction(MI) and depression. Methods PubMed, The Cochrane Library, EMbase, Web of Science, CBM,CNKI, WanFang Data, and VIP databases were searched from inception to December 2017 to collect randomized controlled trials(RCT) on newer-generation antidepressants for patients with MI and depression. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results Ten RCTs involving 552 participants were included. The results showed that the antidepressant group was superior to the placebo or treatment group in terms of the improvement of depressive symptoms(SMD=–1.38, 95%CI –1.93 to –0.82, P<0.000 01), and incidence of angina(RR=0.42, 95%CI 0.25 to 0.71,P=0.001), recurrent MI(RR=0.43, 95%CI 0.22 to 0.83, P=0.01), and re-hospitalization for cardiac reasons(RR=0.51,95%CI 0.28 to 0.92, P=0.03). However, there were no significant differences between two groups on all-cause mortality(RR=0.45, 95%CI 0.18 to 1.11, P=0.08), cardiovascular mortality(RR=0.53, 95%CI 0.16 to 1.73, P=0.29) and incidence of h eart failure(RR=0.75, 95%CI 0.39 to 1.43, P=0.38). Subgroup analysis revealed that the type of antidepressants could affect the improvement of depression outcome. Citalopram and fluoxetine might be the most effective drugs for patients with MI and depression. Conclusions Newer-generation antidepressants are effective for treatment of depressive symptoms in patients with MI and depression, with no significant impact on all-cause mortality and cardiovascular mortality.Moreover, antidepressants can reduce the incidence of angina, recurrent MI, and re-hospitalization for cardiac reasons in patients suffering from MI and depression. Due to limited quantity and quality of included studies, more high quality studies are required to verify above conclusions.更多还原