中药治疗抑郁症的疗效与安全性：随机对照试验的系统评价与Meta分析
Efficacy and safety of Chinese herbal medicine for depression: A systematic review and meta-analysis of randomized controlled trials.
作者信息
Wang Yong, Shi Yi-Hua, Xu Zhen, Fu Huan, Zeng Hua, Zheng Guo-Qing
机构信息
Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
出版信息
J Psychiatr Res. 2019 Oct;117:74-91. doi: 10.1016/j.jpsychires.2019.07.003. Epub 2019 Jul 15.
OBJECTIVE
To conduct a systematic review to assess the current evidence available for the effectiveness and safety of Chinese herbal medicine (CHM) for depression.
METHODS
An electronic search was conducted in eight databases from inception until April 2018. Randomized controlled trials with risk of bias (RoB) score ≥ 4 according to the Cochrane RoB tool were included for analyses. The primary outcome was the severity of depression. The secondary outcomes were total effective rate (TER) and adverse events. The minimally important difference (MID) of the severity of depression was a reduction in the Hamilton Rating Scale for Depression 17 items (HAMD-17) scores by 4. RevMan 5.3 Software was used for data analyses. GRADE system was used to assess the certainty of evidence.
RESULTS
A total of 40 eligible studies with 3549 subjects were identified. Meta-analyses showed that CHM monotherapy had better clinically effects than placebo according to HAMD-17 score (Mean Difference (MD) = -4.53, 95% CI (-5.69, -3.37), P < 0.00001; Certainty of evidence: Moderate) and TER (Risk Ratio (RR) = 2.15, 95% CI (1.61, 2.88), P < 0.00001, Certainty of evidence: Low). Meta-analyses showed that CHM was as effective as western conventional medications (WCM) in TER (RR = 0.99, 95% CI (0.95, 1.02), P = 0.41, Certainty of evidence: High) and in reducing HAMD-17 score (MD = 0.44, 95% CI (-0.11, 0.99), P = 0.12, Certainty of evidence: Moderate). Meta-analyses showed that CHM in combination with WCM was better than WCM in TER (RR = 1.16, 95% CI (1.07, 1.27), P = 0.0004, Certainty of evidence: High), while had comparable clinically effects with WCM according to HAMD-17 score (MD = -2.51, 95% CI (-3.24, -1.77), P < 0.00001, Certainty of evidence: Moderate). In additional, CHM were associated with less adverse events than WCM, and adding CHM to WCM reduced adverse events.
CONCLUSION
The findings of present systematic review, at least to a certain extent, provided supporting evidence for the routine use of CHM for depression.
目的
进行一项系统评价，以评估目前关于中药治疗抑郁症有效性和安全性的现有证据。
方法
从各数据库建库至2018年4月进行电子检索。纳入根据Cochrane偏倚风险（RoB）工具偏倚风险评分≥4的随机对照试验进行分析。主要结局为抑郁严重程度。次要结局为总有效率（TER）和不良事件。抑郁严重程度的最小重要差异是汉密尔顿抑郁量表17项（HAMD-17）评分降低4分。使用RevMan 5.3软件进行数据分析。采用GRADE系统评估证据的确定性。
结果
共纳入40项符合条件的研究，涉及3549名受试者。Meta分析显示，根据HAMD-17评分，中药单一疗法比安慰剂具有更好的临床效果（平均差（MD）=-4.53，95%可信区间（-5.69，-3.3），P<0.00001；证据确定性：中等）和总有效率（风险比（RR）=2.15，95%可信区间（1.61，2.88），P<0.00001，证据确定性：低）。Meta分析显示，中药在总有效率（RR=0.99，95%可信区间（0.95，1.02），P=0.41，证据确定性：高）和降低HAMD-17评分方面（MD=0.44，95%可信区间（-0.11，0.99），P=0.12，证据确定性：中等）与西药常规药物（WCM）效果相当。Meta分析显示，中药联合西药常规药物在总有效率方面优于西药常规药物（RR=1.16，95%可信区间（1.07，1.27），P=0.0004，证据确定性：高），而根据HAMD-17评分，其临床效果与西药常规药物相当（MD=-2.51，95%可信区间（-3.24，-1.77），P<0.00001，证据确定性：中等）。此外，与西药常规药物相比，中药的不良事件较少，在西药常规药物中添加中药可减少不良事件。
结论
本系统评价的结果至少在一定程度上为中药常规用于治疗抑郁症提供了支持性证据。
Zotero 插件