柴胡加龙骨牡蛎汤治疗抑郁症Meta分析
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摘要
目的:通过对柴胡加龙骨牡蛎汤对抑郁症的治疗效果进行Meta分析,为该方剂的临床应用提供参考。方法:以"柴胡加龙骨牡蛎汤""抑郁症""随机"等为关键词,检索2017年6月以前CNKI数据库、维普中文科技期刊数据库、万方数据库、中国生物医学文献数据库,Cochrane Library,Web of Science,Pub Med等数据库,4名研究者采用Cochrane系统评价手册的方法学和质量评价标准进行系统评价,采用Revman5.3软件进行Meta分析。结果:亚组单独使用柴胡加龙骨牡蛎汤[OR=1.55,95%CI(0.73,3.32)],亚组联合抗抑郁药[OR=3.29,95%CI(1.14,9.47)],总体[OR=2.13,95%CI(1.16,3.90)]。总体异质性I2=10%,异质性较小。文献质量分析显示所纳入文献存在一定的发表性偏倚。对比两个亚组可知,联合抗抑郁药的疗效优于单独使用柴胡加龙骨牡蛎汤。8篇文献中有5篇文献提到了不良反应,5篇文献中共有病例干预组174例,对照组171例,其中干预组出现14例不良反应,对照组出现38例不良反应。服用抗抑郁药患者的不良反应率明显高于服用柴胡加龙骨牡蛎汤患者的不良反应率。结论:单用柴胡加龙骨牡蛎汤或者联合抗抑郁药在治疗抑郁症方面效果优于单独使用抗抑郁药,同时柴胡加龙骨牡蛎汤的使用明显降低了服药期间的不良反应发生率。
The curative effect of Bupleurum Combined with Os Draconis and Concha Ostreae Decoction on depression was analyzed by Meta,so as to provide reference for the clinical application of this prescription. Methods: CNKI database VIP Chinese scientific journals database,Wanfang database,China biomedical literature database,Cochrane Library,Web of Science,Pub Med before June 2017 were retrieved by using "Bupleurum Combined with Os Draconis and Concha Ostreae Decoction", "depression",and "random"as key words. The retrieved literatures were evaluated by 4 the researchers independently. The systematic evaluation was conducted by using methodology of using Cochrane system evaluation manual and quality evaluation criteria,and Meta analysis was carried out by using Revman5. 3 software. Results: The subgroup only used Bupleurum Combined with Os Draconis and Concha Ostreae Decoction[OR = 1. 55,95% CI(0. 73,3. 32) ],while the subgroup combination added antidepression drugs [OR = 3. 29,95% CI(1. 14,9. 47) ],overall [OR = 2. 13,95% CI(1. 16,3. 90) ]. The overall heterogeneity was I2 = 10%,and the heterogeneity was small. Of the 8 literatures,5 reported adverse reactions.. Among the 5 literatures,there were 174 cases in the intervention group and 171 cases in the control group. And there were 14 adverse reactions in the intervention group and 38 adverse reactions in the control group. The rate of adverse reaction was significantly higher in patients taking antidepressants than in the patients taking Bupleurum Combined with Os Draconis and Concha Ostreae Decoction. Conclusion: In terms of efficacy,single use of Bupleurum Combined with Os Draconis and Concha Ostreae Decoction,or combination of Bupleurum Combined with Os Draconis and Concha Ostreae Decoction and antidepressant is better than antidepressant alone in the treatment of depression. Meanwhile,the use of Chinese medicine significantly reduces the adverse reaction rate during medication.
The curative effect of Bupleurum Combined with Os Draconis and Concha Ostreae Decoction on depression was analyzed by Meta,so as to provide reference for the clinical application of this prescription. Methods: CNKI database VIP Chinese scientific journals database,Wanfang database,China biomedical literature database,Cochrane Library,Web of Science,Pub Med before June 2017 were retrieved by using "Bupleurum Combined with Os Draconis and Concha Ostreae Decoction", "depression",and "random"as key words. The retrieved literatures were evaluated by 4 the researchers independently. The systematic evaluation was conducted by using methodology of using Cochrane system evaluation manual and quality evaluation criteria,and Meta analysis was carried out by using Revman5. 3 software. Results: The subgroup only used Bupleurum Combined with Os Draconis and Concha Ostreae Decoction[OR = 1. 55,95% CI(0. 73,3. 32) ],while the subgroup combination added antidepression drugs [OR = 3. 29,95% CI(1. 14,9. 47) ],overall [OR = 2. 13,95% CI(1. 16,3. 90) ]. The overall heterogeneity was I2 = 10%,and the heterogeneity was small. Of the 8 literatures,5 reported adverse reactions.. Among the 5 literatures,there were 174 cases in the intervention group and 171 cases in the control group. And there were 14 adverse reactions in the intervention group and 38 adverse reactions in the control group. The rate of adverse reaction was significantly higher in patients taking antidepressants than in the patients taking Bupleurum Combined with Os Draconis and Concha Ostreae Decoction. Conclusion: In terms of efficacy,single use of Bupleurum Combined with Os Draconis and Concha Ostreae Decoction,or combination of Bupleurum Combined with Os Draconis and Concha Ostreae Decoction and antidepressant is better than antidepressant alone in the treatment of depression. Meanwhile,the use of Chinese medicine significantly reduces the adverse reaction rate during medication.
引文
[1]李林艳,徐建.抑郁症治疗进展[J].河南中医,2012,32(12):1720-1722.
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[4]金卫东,邢葆平,王鹤秋,等.柴胡疏肝散治疗抑郁症对照研究临床疗效的Meta分析[J].中华中医药学刊,2009,27(7):1397-1399.
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[6]田景平,温泽淮,郭新峰,等.归脾汤治疗抑郁症疗效与安全性的系统评价[J].中国中医药信息杂志,2016,23(4):36-40.
[7]郑浩涛,赖雯雯,虢周科,等.中医药防治抑郁症系统综述的文献质量评价[J].现代中医药,2015,35(1):68-71.
[8]尚俊平,李巧兰,石洲宝.柴胡加龙骨牡蛎汤治疗老年抑郁症30例[J].甘肃中医,2010,13(2):47-48.
[9]陈卓,丁亮吾.柴胡加龙骨牡蛎汤合百合知母汤治疗抑郁症40例临床观察[J].中医临床研究,2012,4(3):38-39.
[10]段建荣,严贵亮.不同中药复方联合文拉法辛治疗抑郁症的疗效观察[J].现代中药研究与实践,2013,27(5):84-85.
[11]胡元红,杨永朋,王晓燕.柴胡加龙骨牡蛎汤治疗抑郁症临床观察及理论探讨[J].世界最新医学信息文摘(电子版),2016,16(8):204-205.
[12]李林林,刘秀红,徐宝庭.柴胡龙骨牡蛎汤加味联合帕罗西汀治疗抑郁症55例[J].河南中医,2016,36(5):770-772.
[13]徐德毅,赵洁.加味柴胡龙骨牡蛎汤联合帕罗西汀治疗抑郁症的疗效及对患者血清炎症因子、生活质量的影响[J].现代中西医结合杂志,2017,26(12):1303-1305.
[14]张龙生.柴胡龙骨牡蛎汤加减治疗抑郁障碍临床观察[J].河北医药,2010,32(22):3185-3186.
[15]钟向阳,李秋琼,缪雪娜.自拟柴胡加龙骨牡蛎汤加减治疗抑郁症50例[J].中国保健营养,2012,22(20):4746-4747.
[16]邹铭斐.帕罗西汀联合柴胡加龙骨牡蛎汤加味治疗抑郁症42例[J].中国民族民间医药杂志,2016,25(22):68-69.
[17]姜伟超,周亚滨.柴胡桂枝龙骨牡蛎汤加减治疗心脏神经症临床研究[J].中国中医急症,2015,24(7):1146-1148.
[2]张小丽,陈少玫.抑郁障碍的流行病学研究现状分析[J].中医研究,2006,19(6):24-28.
[3]尹冬青.抑郁症中医证候分型诊断量表及证候特征研究[D].北京:北京中医药大学,2013.
[4]金卫东,邢葆平,王鹤秋,等.柴胡疏肝散治疗抑郁症对照研究临床疗效的Meta分析[J].中华中医药学刊,2009,27(7):1397-1399.
[5]庞勇,石佳.针刺治疗产后抑郁临床疗效Meta分析[J].辽宁中医药大学学报,2016,18(7):8-10.
[6]田景平,温泽淮,郭新峰,等.归脾汤治疗抑郁症疗效与安全性的系统评价[J].中国中医药信息杂志,2016,23(4):36-40.
[7]郑浩涛,赖雯雯,虢周科,等.中医药防治抑郁症系统综述的文献质量评价[J].现代中医药,2015,35(1):68-71.
[8]尚俊平,李巧兰,石洲宝.柴胡加龙骨牡蛎汤治疗老年抑郁症30例[J].甘肃中医,2010,13(2):47-48.
[9]陈卓,丁亮吾.柴胡加龙骨牡蛎汤合百合知母汤治疗抑郁症40例临床观察[J].中医临床研究,2012,4(3):38-39.
[10]段建荣,严贵亮.不同中药复方联合文拉法辛治疗抑郁症的疗效观察[J].现代中药研究与实践,2013,27(5):84-85.
[11]胡元红,杨永朋,王晓燕.柴胡加龙骨牡蛎汤治疗抑郁症临床观察及理论探讨[J].世界最新医学信息文摘(电子版),2016,16(8):204-205.
[12]李林林,刘秀红,徐宝庭.柴胡龙骨牡蛎汤加味联合帕罗西汀治疗抑郁症55例[J].河南中医,2016,36(5):770-772.
[13]徐德毅,赵洁.加味柴胡龙骨牡蛎汤联合帕罗西汀治疗抑郁症的疗效及对患者血清炎症因子、生活质量的影响[J].现代中西医结合杂志,2017,26(12):1303-1305.
[14]张龙生.柴胡龙骨牡蛎汤加减治疗抑郁障碍临床观察[J].河北医药,2010,32(22):3185-3186.
[15]钟向阳,李秋琼,缪雪娜.自拟柴胡加龙骨牡蛎汤加减治疗抑郁症50例[J].中国保健营养,2012,22(20):4746-4747.
[16]邹铭斐.帕罗西汀联合柴胡加龙骨牡蛎汤加味治疗抑郁症42例[J].中国民族民间医药杂志,2016,25(22):68-69.
[17]姜伟超,周亚滨.柴胡桂枝龙骨牡蛎汤加减治疗心脏神经症临床研究[J].中国中医急症,2015,24(7):1146-1148.