摘要
目的系统评价5-羟色氨去甲肾上腺素再摄取抑制剂(serotonin noradrenaline reuptake inhibitors,SNRIs)治疗肠易激综合征(irritable bowel syndrome,IBS)的疗效。方法检索Medline、EmBase、Cochrane、Web of Science、中国知网数据库,查找研究SNRIs治疗IBS的随机对照试验(randomized controlled trials,RCTs),检索截止日期为2023年4月28日,对符合纳入标准的文献提取主要信息,采用Cochrane协作网提供的系统评价偏倚风险评估工具进行文献质量评价。运用R 4.3.0软件进行Meta分析,对二分类变量计算症状无改善事件发生的RR和95%CI;对连续型变量计算症状评分标准化平均差(standardized mean difference,SMD)综合数据;并对不同用药进行亚组分析。结果检索文献163篇,最终5篇RCTs符合纳入标准,包括679例IBS患者,进行荟萃分析。二分类变量结果显示:SNRIs治疗组腹痛症状无改善的相对危险度(RR=0.55)明显低于对照组(95%CI:0.46~0.67);连续型变量结果显示:SNRIs能显著降低IBS患者腹痛症状评分(SMD=-1.63,95%CI:-2.96--0.31)、焦虑量表评分(SMD=-1.23,95%CI:-2.33~-0.13)、抑郁量表评分(SMD=-1.06,95%CI:-2.01~-0.11)。结论SNRIs能显著改善IBS患者腹痛以及合并的抑郁、焦虑状态,支持其用于IBS尤其是合并抑郁和焦虑患者的治疗。
Objective To systematically evaluate the efficacy of serotonin noradrenaline reuptake inhibitors(SNRIs)in the treatment of irritable bowel syndrome(IBS).Methods Medline,EmBase,Cochrane,Web of Science,and China Knowledge Network databases were searched for randomized controlled trials(RCTs)of SNRIs for treatment of IBS.The cut-off date was Apr.28,2023,and the main information was extracted from the literature that met the inclusion criteria,and the quality of the literature was evaluated using the systematic evaluation risk assessment tool provided by the Cochrane Collaboration.Meta-analysis was performed using R 4.3.0 software.Dichotomous variables were pooled to obtain RR and 95%CI for the occurrence of symptom unimprovement events.Continuous variables were pooled and converted into standardized mean difference(SMD)and subgroup analysis was performed for different medications.Results The literature was searched for 163 articles,of which 5 RCTs met the inclusion criteria and involved 679 patients with IBS for Meta-analysis.The results of the dichotomous variables showed that the RR of unimprovement in abdominal pain of IBS patients was significantly lower in the SNRIs group compared with the control group who were receiving placebo or traditional treatment(RR=0.55,95%CI:0.46-0.67).For the continuous type of variables,SNRIs significantly improved abdominal pain symptom scores(SMD=-1.63,95%CI:-2.96--0.31).Besides,the anxiety scale scores(SMD=-1.23,95%CI:-2.33--0.13)and depression scale scores(SMD=-1.06,95%CI:-2.01--0.11)of IBS patients significantly decreased.Conclusion Existing evidence suggests that SNRIs have significant efficacy in improving abdominal pain and comorbid anxiety and depression in IBS patients.
作者
付铭玉
费贵军
杨萱瑾
方秀才
FU Mingyu;FEI Guijun;YANG Xuanjin;FANG Xiucai(Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Gynecology and Obstetrics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)
出处
《胃肠病学和肝病学杂志》
2025年第1期11-17,共7页
Chinese Journal of Gastroenterology and Hepatology
基金
国家重点研发计划课题(2022YFC2504004)。
