抗精神病药物合并电抽搐治疗对难治性精神分裂症患者的疗效和安全性：一项系统综述和meta分析
背景：抗精神病药物合并电抽搐治疗（electroconvulsive therapy,ECT）对难治性精神分裂症患者的疗效和安全性还不确定。目的：对电抽搐治疗在难治性精神分裂症中的应用的相关中英文文献进行系统综述和meta分析。方法：在中英文数据库中检索2015年5月20日前发表的关于抗精神病药物合并ECT治疗难治性精神分裂症疗效和安全性的研究。由两名研究人员根据预先设定的标准独立筛选和评估文献。采用Review Manager5.1软件进行数据分析。结果：共纳入22项随机对照研究,其中在中国大陆开展的研究有18项。本研究对22项研究中的18项研究共1394例样本进行meta分析后发现,相比于...
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| Published in | 上海精神医学 Vol. 27; no. 4; pp. 206 - 219 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Chinese |
| Published |
2015
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1002-0829 |
| DOI | 10.11919/j.issn.1002-0829.215093 |
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| Abstract | 背景：抗精神病药物合并电抽搐治疗（electroconvulsive therapy,ECT）对难治性精神分裂症患者的疗效和安全性还不确定。目的：对电抽搐治疗在难治性精神分裂症中的应用的相关中英文文献进行系统综述和meta分析。方法：在中英文数据库中检索2015年5月20日前发表的关于抗精神病药物合并ECT治疗难治性精神分裂症疗效和安全性的研究。由两名研究人员根据预先设定的标准独立筛选和评估文献。采用Review Manager5.1软件进行数据分析。结果：共纳入22项随机对照研究,其中在中国大陆开展的研究有18项。本研究对22项研究中的18项研究共1394例样本进行meta分析后发现,相比于单独使用抗精神病药物,抗精神病药物合并ECT治疗达到各研究特定的＂临床改善＂标准的比例要显著高（RR=1.31,95%CI=1.22-1.41）。根据推荐GTADE分级的评估、制定和评价标准（Grades of Recommendation,Assessment,Development,and Evaluation,GRADE）,该疗效评估的证据质量是＂中等＂。但是,在治疗过程中出现头痛的参与者比例在合并治疗组中显著更高（RR=9.10,95%CI=3.97-20.86,基于8项研究517例样本）。合并治疗组中出现记忆受损的患者的比例也高（RR=6.48,95%CI=3.54-11.87,基于7项研究577例样本）。这些不良反应的证据质量被评定为＂非常低＂。结论：有关抗精神病药物合并ECT治疗难治性精神分裂症的高质量随机对照临床试验很少。该meta分析发现,抗精神病药物合并ECT可以改善难治性精神分裂症患者的精神症状,但大多数研究提供的方法学信息不全,存在发表偏倚（更偏向于合并治疗组结果相对好的研究）,有关不良反应、认知受损和整体功能的证据质量较低,这使我们需要对结果的效度有所质疑。 |
|---|---|
| AbstractList | 背景：抗精神病药物合并电抽搐治疗(electroconvulsive therapy, ECT)对难治性精神分裂症患者的疗效和安全性还不确定。目的：对电抽搐治疗在难治性精神分裂症中的应用的相关中英文文献进行系统综述和meta分析。方法：在中英文数据库中检索2015年5月20日前发表的关于抗精神病药物合并ECT治疗难治性精神分裂症疗效和安全性的研究。由两名研究人员根据预先设定的标准独立筛选和评估文献。采用Review Manager 5.1软件进行数据分析。结果：共纳入22项随机对照研究，其中在中国大陆开展的研究有18项。本研究对22项研究中的18项研究共1394例样本进行meta分析后发现，相比于单独使用抗精神病药物，抗精神病药物合并ECT治疗达到各研究特定的“临床改善”标准的比例要显著高(RR=1.31,95%CI=1.22-1.41)。根据推荐GTADE分级的评估、制定和评价标准(Grades of Recommendaiton, Assessment, Development, and Evaluaiton, GRADE)，该疗效评估的证据质量是“中等”。但是，在治疗过程中出现头痛的参与者比例在合并治疗组中显著更高（RR=9.10,95%CI=3.97-20.86，基于8项研究517例样本）。合并治疗组中出现记忆受损的患者的比例也高（RR=6.48，95% CI=3.54-11.87，基于7项研究577例样本）。这些不良反应的证据质量被评定为“非常低”。结论：有关抗精神病药物合并ECT治疗难治性精神分裂症的高质量随机对照临床试验很少。该meta分析发现，抗精神病药物合并ECT可以改善难治性精神分裂症患者的精神症状，但大多数研究提供的方法学信息不全，存在发表偏倚（更偏向于合并治疗组结果相对好的研究），有关不良反应、认知受损和整体功能的证据质量较低，这使我们需要对结果的效度有所质疑。 背景：抗精神病药物合并电抽搐治疗（electroconvulsive therapy,ECT）对难治性精神分裂症患者的疗效和安全性还不确定。目的：对电抽搐治疗在难治性精神分裂症中的应用的相关中英文文献进行系统综述和meta分析。方法：在中英文数据库中检索2015年5月20日前发表的关于抗精神病药物合并ECT治疗难治性精神分裂症疗效和安全性的研究。由两名研究人员根据预先设定的标准独立筛选和评估文献。采用Review Manager5.1软件进行数据分析。结果：共纳入22项随机对照研究,其中在中国大陆开展的研究有18项。本研究对22项研究中的18项研究共1394例样本进行meta分析后发现,相比于单独使用抗精神病药物,抗精神病药物合并ECT治疗达到各研究特定的＂临床改善＂标准的比例要显著高（RR=1.31,95%CI=1.22-1.41）。根据推荐GTADE分级的评估、制定和评价标准（Grades of Recommendation,Assessment,Development,and Evaluation,GRADE）,该疗效评估的证据质量是＂中等＂。但是,在治疗过程中出现头痛的参与者比例在合并治疗组中显著更高（RR=9.10,95%CI=3.97-20.86,基于8项研究517例样本）。合并治疗组中出现记忆受损的患者的比例也高（RR=6.48,95%CI=3.54-11.87,基于7项研究577例样本）。这些不良反应的证据质量被评定为＂非常低＂。结论：有关抗精神病药物合并ECT治疗难治性精神分裂症的高质量随机对照临床试验很少。该meta分析发现,抗精神病药物合并ECT可以改善难治性精神分裂症患者的精神症状,但大多数研究提供的方法学信息不全,存在发表偏倚（更偏向于合并治疗组结果相对好的研究）,有关不良反应、认知受损和整体功能的证据质量较低,这使我们需要对结果的效度有所质疑。 |
| Abstract_FL | Background:The efficacy and safety of the combined treatment of refractory schizophrenia with anitpsychoitc medicaitons and electroconvulsive therapy (ECT) remain uncertain. Aim: Conduct systemaitc review and meta-analysis of available literature in English and China about ECT in the treatment of refractory schizophrenia. Methods:English and Chinese databases were searched for studies published prior to May 20, 2015 regarding the effcacy and safety of the combined treatment of refractory schizophrenia with anitpsychoitc medications and ECT. Two researchers selected and evaluated studies independently using pre-defined criteria. Review Manager 5.1 sotfware was used for data analysis. Results:A total of 22 randomized control studies, 18 of which were conducted in mainland China, were included in the analysis. Meta-analysis of data from 18 of the 22 studies with a pooled sample of 1394 individuals found that compared to treatment with anitpsychoitc medicaitons alone, combined treatment with anitpsychoitc medicaitons and ECT had signiifcantly higher rates of achieving study-speciifc criteria of ‘clinical improvement’ (RR=1.25, 95%CI=1.14-1.37). Based on the Grades of Recommendaiton, Assessment, Development, and Evaluaiton (GRADE) criteria, the quality of evidence for this assessment of effcacy was ‘moderate’. However, the proporiton of paritcipants who experienced headache during the treatment was signiifcantly higher in the combined treatment group (RR=9.10, 95%CI=3.97-20.86, based on a pooled sample of 517 from 8 studies) and the proportion who experienced memory impairment was also higher in the combined treatment group (RR=6.48, 95%CI=3.54-11.87, based on a pooled sample of 577 from 7 studies). The quality of evidence about these adverse events was rated as ‘very low’. Conclusions:There are very few high quality randomized controlled clinical trials about the combinaiton of anitpsychoitc medicaitons and ECT in the treatment of refractory schizophrenia. This meta-analysis found that the combinaiton of anitpsychoitc medicaitons and ECT could improve psychiatric symptoms in paitents with refractory schizophrenia, but the incomplete methodological information provided for most of the studies, publication bias (favoring studies with better outcomes in the combined treatment group), and the low quality of evidence about adverse outcomes, cognitive impairment, and overall functioning raise quesitons about the validity of the results. |
| Author | 王文政 蒲城城 蒋江灵 曹歆轶 王继军 赵敏 李春波 |
| AuthorAffiliation | Shanghai Key Laboratory of Psychotic Disorders, Shanghai Research Institute of Mental Health, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China Peking University Sixth Hospital Institute of Mental Health, Mental Health Institute of Peking University, Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China |
| Author_FL | Min ZHAO Wenzheng WANG Qinyi CAO Chunbo LI Jijun WANG Chengcheng PU Jiangling JIANG |
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| DOI | 10.11919/j.issn.1002-0829.215093 |
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| DocumentTitleAlternate | Efficacy and safety of treating patients with refractory schizophrenia with antipsychotic medication and adjunctive electroconvulsive therapy： a systematic review and meta-analysis |
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| Keywords | meta分析 refractory schizophreinia 电抽搐治疗 系统综述 难治性精神分裂症 meta-analysis electroconvulsive therapy systematic review 抗精神病药物 antipsychotic medication |
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| Notes | electroconvulsive therapy; antipsychotic medication; refractory schizophreinia; systematic review; meta-analysis Background： The efficacy and safety of the combined treatment of refractory schizophrenia with antipsychotic medications and electroconvulsive therapy（ECT） remain uncertain.Aim： Conduct systematic review and meta-analysis of available literature in English and China about ECT in the treatment of refractory schizophrenia.Methods： English and Chinese databases were searched for studies published prior to May 20, 2015 regarding the efficacy and safety of the combined treatment of refractory schizophrenia with antipsychotic medications and ECT. Two researchers selected and evaluated studies independently using pre-defined criteria. Review Manager 5.1 software was used for data analysis.Results： A total of 22 randomized control studies, 18 of which were conducted in mainland China, were included in the analysis. Meta-analysis of data from 18 of the 22 studies with a pooled sample of 1394 individuals foun |
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| PublicationTitle | 上海精神医学 |
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| Snippet | 背景：抗精神病药物合并电抽搐治疗（electroconvulsive therapy,ECT）对难治性精神分裂症患者的疗效和安全性还不确定。目的：对电抽搐治疗在难治性精神分裂症中的应用的相... 背景：抗精神病药物合并电抽搐治疗(electroconvulsive therapy, ECT)对难治性精神分裂症患者的疗效和安全性还不确定。目的：对电抽搐治疗在难治性精神分裂症中的应用的相关... |
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| SubjectTerms | meta分析 抗精神病药物 电抽搐治疗 系统综述 难治性精神分裂症 |
| Title | 抗精神病药物合并电抽搐治疗对难治性精神分裂症患者的疗效和安全性：一项系统综述和meta分析 |
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