谷氨酸能药物作为强迫症治疗的附加药物：一项系统评价和荟萃分析
Glutamatergic Agents as Add-On Medication for the Treatment of Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis.
作者信息
Laoutidis Zacharias G, Lekka Georgia E, Kioulos Kanellos T
机构信息
Department of Psychiatry and Psychotherapy, Medical Faculty of the Heinrich Heine University, Bergische Landstrasse 2, 40629 Düsseldorf, Germany.
Department of Psychiatry and Psychotherapy, Medical Faculty of the Heinrich Heine University, Düsseldorf, Germany.
出版信息
J Clin Psychiatry. 2016 Dec;77(12):e1576-e1583. doi: 10.4088/JCP.15r10164.
OBJECTIVE
The aim of the present study was to review the existing literature on clinical trials with glutamatergic agents in adults with obsessive-compulsive disorder (OCD) and to perform a meta-analysis to estimate the overall effect size.
DATA SOURCES
We searched in MEDLINE, Embase, and the Cochrane Library for eligible studies, using the following search terms: (glutamate OR glutaminergic OR glutamatergic OR NMDA OR AMPA OR kainate) AND (obsessive-compulsive disorder OR obsessive OR compulsive OR OCD). A separate search was performed for generally known glutamatergic agents. The databases were searched for articles published by May 31, 2015.
STUDY SELECTION
Eligible studies were double-blind, randomized controlled trials that tested the efficacy of add-on treatment with a glutamatergic agent in patients with OCD.
DATA EXTRACTION
Data were extracted independently by 2 reviewers. We extracted dichotomous data (number of patients with response and remission) to estimate relative risk ratios (RRs), as well as continuous data (scores in Yale-Brown Obsessive Compulsive Scale and Clinical Global Impressions-Severity of Illness and -Improvement scales), which were used to estimate standardized mean differences. Effect sizes were estimated using a random-effects model.
RESULTS
Eight randomized controlled trials were identified. The overall ratio for response was RR = 3.71 (95% CI, 2.35-5.83; P < .001). When limited to the studies with treatment-resistant patients, the effect size remained significant (RR = 4.30; 95% CI, 2.19-8.43; P < .001). Secondary outcomes, such as the standardized mean differences for continuous data, showed the statistically significant superiority (P < .001) of glutamatergic agents over placebo. The risk of dropouts was RR = 1.18 (95% CI, 0.83-1.69; P = .361) and the risk of dropouts due to adverse effects was RR = 3.04 (95% CI, 1.57-5.89; P = .001).
CONCLUSIONS
Glutamatergic agents are effective as add-on treatment for OCD in general and especially for treatment-refractory OCD.
目的
本研究旨在回顾关于成人强迫症（OCD）患者使用谷氨酸能药物的临床试验的现有文献，并进行荟萃分析以估计总体效应大小。
数据来源
我们在MEDLINE、Embase和Cochrane图书馆中检索符合条件的研究，使用以下检索词：（谷氨酸或谷氨酰胺能或谷氨酸能或N-甲基-D-天冬氨酸或α-氨基-3-羟基-5-甲基-4-异恶唑丙酸或海人酸）和（强迫症或强迫观念或强迫行为或OCD）。对一般已知的谷氨酸能药物进行了单独检索。检索数据库中截至2015年5月31日发表的文章。
研究选择
符合条件的研究为双盲、随机对照试验，测试了在OCD患者中添加谷氨酸能药物治疗的疗效。
数据提取
由2名审阅者独立提取数据。我们提取二分数据（有反应和缓解的患者数量）以估计相对风险比（RRs），以及连续数据（耶鲁-布朗强迫症量表和临床总体印象-疾病严重程度和-改善量表中的得分），用于估计标准化均数差。使用随机效应模型估计效应大小。
结果
确定了8项随机对照试验。总体反应比为RR = 3.71（95%CI，2.35 - 5.83；P <.001）。当仅限于对难治性患者的研究时，效应大小仍然显著（RR = 4.30；95%CI，2.19 - 8.43；P <.001）。次要结局，如连续数据的标准化均数差，显示谷氨酸能药物在统计学上显著优于安慰剂（P <.001）。退出风险为RR = 1.18（95%CI，0.83 - 1.69；P =.361），因不良反应导致的退出风险为RR = 3.04（95%CI，1.57 - 5.89；P =.001）。
结论
谷氨酸能药物作为OCD的附加治疗总体上是有效的，尤其是对难治性OCD。
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