非药物干预对抗精神病药相关体重增加和代谢异常的急性和维持效果：随机对照试验的荟萃分析比较。
Acute and maintenance effects of non-pharmacologic interventions for antipsychotic associated weight gain and metabolic abnormalities: a meta-analytic comparison of randomized controlled trials.
机构信息
Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA.
出版信息
Schizophr Res. 2012 Sep;140(1-3):159-68. doi: 10.1016/j.schres.2012.03.017. Epub 2012 Jul 3.
OBJECTIVE
To evaluate the efficacy of non-pharmacological interventions for antipsychotic-associated weight gain.
METHODS
Systematic literature search and meta-analysis of randomized controlled trials comparing behavioral interventions with control groups to ameliorate antipsychotic-associated weight gain.
RESULTS
Across 17 studies (n=810, mean age: 38.8 years, 52.7% male, 40.8% White, 85.6% with schizophrenia-spectrum disorders), non-pharmacological interventions led to a significant reduction in weight (-3.12 kg; CI: -4.03, -2.21, p<0.0001) and body mass index (BMI) (-0.94 kg/m²; CI: -1.45, -0.43, p=0.0003) compared with control groups. Intervention benefits extended to all secondary outcomes, except for high density-lipoprotein-cholesterol and systolic blood pressure. Compared to controls, intervention patients experienced significant decreases in waist circumference (WMD=-3.58 cm, CI: -5.51, -1.66, p=0.03), percent body fat (WMD=-2.82%, CI: -5.35, -0.30, p=0.03), glucose (WMD=-5.79 mg/dL, CI: -9.73, -1.86, p=0.004), insulin (WMD=-4.93 uIU/mL, CI: -7.64, -2.23, p=0.0004), total cholesterol (WMD=-20.98 mg/dL, CI: -33.78, -8.19; p=0.001), low density-lipoprotein-cholesterol (WMD=-22.06 mg/dL, CI: -37.80, -6.32, p=0.006) and triglycerides (WMD=-61.68 mg/dL, CI: -92.77, -30.59, p=0.0001), and less weight gain >7% (29.7% vs. 61.3%; RR=-0.52, CI: -0.35, -0.78, p=0.002; number-needed-to-treat=4). Up to 12 months after the intervention ended (mean=3.6 months), benefits endured regarding weight (WMD=-3.48 kg, CI: -6.37, -0.58, p=0.02), but not BMI (p=0.40). Subgroup analyses showed superiority of non-pharmacological interventions irrespective of treatment duration, individual or group, cognitive behavioral or nutritional interventions, or prevention versus intervention trials. However, weight and BMI were significantly improved only in outpatient trials (p<0.0001), but not in inpatient or mixed samples (p=0.09-0.96).
CONCLUSION
Behavioral interventions effectively prevented and reduced antipsychotic-associated weight gain and cardiometabolic perturbations, at least in outpatients agreeing to participate in trials aimed at improving physical health. Effective treatments ranged from nutritional interventions to cognitive behavioral therapy.
目的
评估非药物干预措施对抗精神病药相关体重增加的疗效。
方法
系统文献检索和随机对照试验的荟萃分析，比较行为干预与对照组，以改善抗精神病药相关体重增加。
结果
在 17 项研究中（n=810，平均年龄：38.8 岁，52.7%为男性，40.8%为白人，85.6%为精神分裂症谱系障碍），与对照组相比，非药物干预可显著降低体重（-3.12kg；CI：-4.03，-2.21，p<0.0001）和体重指数（BMI）（-0.94kg/m²；CI：-1.45，-0.43，p=0.0003）。干预的益处扩展到所有次要结局，高密度脂蛋白胆固醇和收缩压除外。与对照组相比，干预组患者的腰围（WMD=-3.58cm，CI：-5.51，-1.66，p=0.03）、体脂百分比（WMD=-2.82%，CI：-5.35，-0.30，p=0.03）、血糖（WMD=-5.79mg/dL，CI：-9.73，-1.86，p=0.004）、胰岛素（WMD=-4.93uIU/mL，CI：-7.64，-2.23，p=0.0004）、总胆固醇（WMD=-20.98mg/dL，CI：-33.78，-8.19；p=0.001）、低密度脂蛋白胆固醇（WMD=-22.06mg/dL，CI：-37.80，-6.32，p=0.006）和甘油三酯（WMD=-61.68mg/dL，CI：-92.77，-30.59，p=0.0001）显著降低，体重增加>7%的比例（29.7%vs.61.3%；RR=-0.52，CI：-0.35，-0.78，p=0.002；需要治疗人数=4）也较低。干预结束后 12 个月（平均 3.6 个月），体重仍有获益（WMD=-3.48kg，CI：-6.37，-0.58，p=0.02），但 BMI 无获益（p=0.40）。亚组分析表明，无论治疗持续时间、个体或群体、认知行为或营养干预，还是预防与干预试验，非药物干预均具有优越性。然而，仅在门诊试验中体重和 BMI 得到显著改善（p<0.0001），而在住院或混合样本中则没有改善（p=0.09-0.96）。
结论
行为干预可有效预防和减少抗精神病药相关的体重增加和代谢紊乱，至少在同意参与改善身体健康试验的门诊患者中如此。有效的治疗方法范围从营养干预到认知行为疗法。
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