别嘌醇作为双相情感障碍躁狂症状的附加治疗：随机对照试验的系统评价和荟萃分析。
Allopurinol as add-on treatment for mania symptoms in bipolar disorder: systematic review and meta-analysis of randomised controlled trials.
机构信息
Francesco Bartoli, MD, PhD, Cristina Crocamo, MSc, Massimo Clerici, MD, PhD, Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy; Giuseppe Carrà, MD, PhD, Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy, and Division of Psychiatry, University College London, London, UK
Francesco Bartoli, MD, PhD, Cristina Crocamo, MSc, Massimo Clerici, MD, PhD, Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy; Giuseppe Carrà, MD, PhD, Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy, and Division of Psychiatry, University College London, London, UK.
出版信息
Br J Psychiatry. 2017 Jan;210(1):10-15. doi: 10.1192/bjp.bp.115.180281. Epub 2016 Nov 17.
BACKGROUND
Since bipolar disorder seems to be associated with purinergic system dysfunction, allopurinol might be effective in treating symptoms of mania.
AIMS
To estimate the efficacy and tolerability of allopurinol as adjunctive treatment for mania symptoms in people with bipolar affective disorder.
METHOD
We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing the effects of adjunctive allopurinol and placebo on mania symptom changes.
RESULTS
Five RCTs were included in the meta-analysis. Participants with allopurinol augmentation had a significantly greater decrease in mania symptoms than those with placebo (SMD = -0.34, P = 0.007), especially in people with the most severe forms of mania. Remission rates, although based on only two studies (n = 177), were significantly higher among individuals receiving allopurinol, whereas for discontinuation and side-effects no difference was found.
CONCLUSIONS
Our finding of a small to moderate effect size and overall low evidence for add-on allopurinol in reducing mania symptoms indicate that its use in routine practice needs further elucidation.
背景
由于双相情感障碍似乎与嘌呤能系统功能障碍有关，别嘌醇可能对治疗躁狂症状有效。
目的
评估别嘌醇作为双相情感障碍患者辅助治疗躁狂症状的疗效和耐受性。
方法
我们对随机对照试验（RCT）进行了系统评价和荟萃分析，比较了辅助别嘌醇和安慰剂对躁狂症状变化的影响。
结果
五项 RCT 纳入荟萃分析。与安慰剂相比，接受别嘌醇加用的参与者躁狂症状明显减轻（SMD = -0.34，P = 0.007），尤其是在躁狂症状最严重的人群中。尽管只有两项研究（n = 177）报告了缓解率，但接受别嘌醇的患者缓解率明显更高，而在停药和不良反应方面没有差异。
结论
我们发现别嘌醇在降低躁狂症状方面的效应量较小到中等，且总体证据质量较低，这表明其在常规实践中的应用需要进一步阐明。
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