Su Ning, Wen Changming, Guo Shiqian, Yu Yang, Wang Chenglin
Department of Neurology, Nanyang Central Hospital, Nanyang, China.
Front Neurol. 2021 Oct 20;12:749322. doi: 10.3389/fneur.2021.749322. eCollection 2021.
To explore the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) for motor recovery in non-depressed patients after acute stroke. According to the predefined retrieval strategy, multiple electronic databases were searched for randomized controlled trials (RCTs) that met the inclusion criteria. The primary efficacy outcome was measured by Fugl-Meyer Motor Scale (FMMS) score and the indicators of tolerability included withdrawal rate and the incidence of adverse events (AEs). 10RCTs were included, the pooled analyses showed patients who received fluoxetine (endpoint: MD = 21.17, 95% CI 14.13-28.21, < 0.00001; mean change: MD = 16.27, 95% CI 10.05-22.50, < 0.00001) and citalopram (endpoint: MD = 22.93, 95% CI 11.13-34.73, = 0.0001; mean change: MD = 24.06, 95% CI 10.47-37.65, = 0.0005) experienced greater improvement in FMMS score. There was no evident difference in total withdrawal rate (fluoxetine: OR = 1.11, 95% CI 0.90-1.27, = 1.38; citalopram: OR = 0.94, 95% CI 0.69-1.28, = 0.71; escitalopram: OR = 0.87, 95% CI 0.58-1.28, = 0.47) between two groups. Besides, the incidence of hyponatremia (OR = 2.01, 95% CI 1.16-3.50, = 0.01), seizure (OR = 1.46, 95% CI 1.03-2.08, = 0.04) and fracture (OR = 2.34, 95% CI 1.61-3.40, < 0.00001) in the fluoxetine group was higher than in the placebo group. Fluoxetine and citalopram can promote motor recovery in non-depressed patients with acute stroke, but it is necessary to pay attention to the possible AEs of fluoxetine, such as hyponatremia, seizure and fracture. PROSPERO, identifier [CRD42021227452].
探讨选择性5-羟色胺再摄取抑制剂（SSRIs）对急性卒中后非抑郁患者运动功能恢复的疗效及耐受性。根据预先设定的检索策略，检索多个电子数据库，查找符合纳入标准的随机对照试验（RCT）。主要疗效指标采用Fugl-Meyer运动量表（FMMS）评分，耐受性指标包括撤药率和不良事件（AE）发生率。共纳入10项RCT，汇总分析显示，接受氟西汀治疗的患者（终点：MD = 21.17，95%CI 14.13 - 28.21，P < 0.00001；平均变化：MD = 16.27，95%CI 10.05 - 22.50，P < 0.00001）和西酞普兰治疗的患者（终点：MD = 22.93，95%CI 11.13 - 34.73，P = 0.0001；平均变化：MD = 24.06，95%CI 10.47 - 37.65，P = 0.0005）在FMMS评分上有更大改善。两组的总撤药率无明显差异（氟西汀：OR = 1.11，95%CI 0.90 - 1.27，P = 1.38；西酞普兰：OR = 0.94，95%CI 0.69 - 1.28，P = 0.71；艾司西酞普兰：OR = 0.87，95%CI 0.58 - 1.28，P = 0.47）。此外，氟西汀组低钠血症（OR = 2.01，95%CI 1.16 - 3.50，P = 0.01）、癫痫（OR = 1.46，95%CI 1.03 - 2.08，P = 0.04）和骨折（OR = 2.34，95%CI 1.61 - 3.40，P < 0.00001）的发生率高于安慰剂组。氟西汀和西酞普兰可促进急性卒中非抑郁患者的运动功能恢复，但有必要关注氟西汀可能的不良事件，如低钠血症、癫痫和骨折。国际前瞻性系统评价注册库（PROSPERO），标识符[CRD42021227452]
