选择性5-羟色胺再摄取抑制剂治疗脑卒中对功能独立影响的Meta分析

黄超平 陈素芬 胡珏

[摘要] 目的 系統评价在脑卒中早期（发病15 d内）使用选择性5-羟色胺再摄取抑制剂（SSRIs）治疗对功能独立的安全性和有效性。 方法 计算机检索中国知网全文数据库、万方数据库、维普中文数据库、PubMed、Embase、The Cochrane Library数据库，搜索关于SSRIs与安慰剂对比治疗脑卒中的随机对照试验（RCT），检索时限均从建库至2020年8月31日。采用 RevMan 5.3 软件与Stata16进行Meta 分析。 结果 共纳入5项RCT，包括5462例患者。Meta分析结果显示，与对照组相比，早期使用SSRIs不能改善脑卒中患者的功能独立[OR=1.44，95%CI（0.89～2.34），P=0.14];可显著降低卒中后抑郁的发病率[OR=0.69，95%CI（0.59～0.81），P<0.000 01];但增加骨折的风险[OR=2.19，95%CI（1.44～3.32），P=0.0002];两组在死亡、卒中复发、癫痫等方面比较，差异无统计学意义（P>0.05）。结论 早期使用SSRIs治疗不能显著改善脑卒中患者的功能独立，不支持作为脑卒中的常规治疗策略。

[关键词] 选择性5-羟色胺再摄取抑制剂;脑卒中;Meta分析;功能独立;随机对照试验

[中图分类号] R794.4          [文献标识码] A          [文章编号] 1673-9701（2021）24-0018-06

Meta-analysis of effect of selective serotonin reuptake inhibitors on function independence in treatment of stroke

HUANG Chaoping1   CHEN Sufen2   HU Jue2

1.Hunan University of Chinese Medicine， Changsha   410208，China; 2.Department of Neurology， Changsha Central Hospital， Changsha   410000，China

[Abstract] Objective To systematically evaluate the safety and effectiveness of selective serotonin reuptake inhibitors （SSRIs） for functional independence in the treatment of early stage of stroke （within 15 days of onset）. Methods The CNKI full-text database， Wanfang database， VIP Chinese database， PubMed， Embase， and Cochrane Library database were searched for randomized controlled trials （RCTs） on SSRIs versus placebo in the treatment of stroke. The date searched was limited as from the establishment of the database to August 31， 2020. Meta-analysis was performed using RevMan 5.3 software and Stata16. Results A total of 5 RCTs were included， including 5462 patients. Meta-analysis results showed that compared with the control group， early use of SSRIs could not improve the function independence in stroke patients [OR=1.44， 95%CI （0.89-2.34）， P=0.14]. It significantly reduced the incidence of post-stroke depression [OR=0.69， 95%CI （0.59-0.81）， P<0.000 01]， but increased the risk of fracture [OR=2.19， 95%CI （1.44-3.32）， P=0.0002]. There were no statistically significant differences in death， stroke recurrence and epilepsy between the two groups. Conclusion The current research evidence shows that early treatment with SSRIs cannot significantly improve the function independence in stroke patients and does not support the use of SSRIs as a conventional treatment strategy for stroke.

[Key words] Selective serotonin reuptake inhibitors; Stroke; Meta-analysis; Function independence; Randomized controlled trials