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·循证药学·

艾司西酞普兰治疗抑郁症的系统评价再评价
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李会全 ，李小江，张雪娟（济源市第六人民医院精神二科，河南 济源 454650）

中图分类号 R749.053；R971 .43 文献标志码 A 文章编号 1001-0408（2023）01-0091-06
+
DOI 10.6039/j.issn.1001-0408.2023.01.18
摘 要 目的 对艾司西酞普兰治疗抑郁症的系统评价/Meta分析进行再评价，以期为该药的临床应用提供参考。方法 计算机检
索中国知网、万方数据库、维普网、SinoMed、PubMed、Cochrane Library 等数据库中艾司西酞普兰治疗抑郁症的系统评价/Meta分
析，检索时限为建库至2022年5月17日。根据纳排标准筛选文献，提取纳入文献的基本信息，使用AMSTAR 2量表、PRISMA声
明、GRADE系统分别对纳入文献的方法学质量、报告质量与证据质量进行评价。结果 共纳入16篇系统评价/Meta分析，有效性
比较结果表明，艾司西酞普兰治疗抑郁症在提高总有效率方面，疗效不劣于舍曲林，与度洛西汀、氟西汀等效果相当；在提高痊愈
率方面，与帕罗西汀、度洛西汀及氟西汀等效果相当；安全性比较结果表明，艾司西酞普兰的安全性高于帕罗西汀、文拉法辛等。
AMSTAR 2量表方法学质量评价整体偏低，均评价为极低级，多条关键条目的缺失是主要原因；PRISMA得分在12～23分之间，其
中得分＞21分的有5篇文献，报告相对完整，得分在15～21分的有10篇文献，报告具有一定的缺陷，得分≤15分的有1篇文献，信
息缺失严重；GRADE 证据分级结果显示，纳入的 160 个结局指标中，69 个为中级证据，64 个为低级证据，27 个为极低级证据。
结论 艾司西酞普兰提高抑郁症患者总有效率不劣于舍曲林；相较于帕罗西汀，艾司西酞普兰等安全性更高。但上述结论证据等
级较低。
关键词 艾司西酞普兰；抑郁症；系统评价再评价；循证医学

Escitalopram in the treatment of depression： an overview of systematic review
LI Huiquan，LI Xiaojiang，ZHANG Xuejuan（Dept. Two of Psychiatry， the Sixth People’s Hospital of Jiyuan，
Henan Jiyuan 454650， China）

ABSTRACT OBJECTIVE To re-evaluate systematic review/meta-analysis of escitalopram in the treatment of depression， and to
provide reference for clinical use of escitalopram. METHODS Retrieved from CNKI， Wanfang database， VIP， SinoMed， PubMed
and the Cochrane Library， etc.， systematic review/meta-analysis of escitalopram in the treatment of depression were collected from
the construction of the database to May 17， 2022. The literatures were screened according to the inclusion and exclusion criteria，
the basic information of the included literatures was extracted， and the methodological quality， reporting quality and evidence
quality of the included literatures were evaluated by using AMSTAR 2 scale， PRISMA statement， and GRADE system，
respectively. RESULTS A total of 16 systematic reviews/meta-analyses were included. The results of efficacy comparison showed
that escitalopram in the treatment of depression was superior to sertraline in improving the total effective rate， and was comparable
to paroxetine， duloxetine and fluoxetine in improving cure rate. The results of safety comparison showed that the safety of
escitalopram was higher than that of paroxetine and venlafaxine. The overall methodological quality evaluation of AMSTAR 2 scale
was low， and all of them were rated as extremely low； main reason was the lack of many key items. PRISMA score was between
12 and 23 points. Among them， there were 5 literatures with scores ＞21 points， and the reports were relatively complete， 10
literatures with scores between 15 and 21 points， and the reports had certain defects， and 1 literature with scores ≤15 points， with
serious information missing. The results of the grading of GRADE evidence showed that， of the 160 included outcome indicators，
69 were moderate evidence， 64 were low-level evidence， and 27 were very low-level evidence. CONCLUSIONS The total
effective rate of escitalopram in improving depressive patients is not inferior to that of sertraline； compared with paroxetine，
escitalopram is safer. However， the evidence level of the above conclusions is low.
KEYWORDS escitalopram； depression； overview of systematic review； evidence-based medicine

抑郁症是一种以长期心情抑郁、思维迟缓、兴致缺 体质量减轻等躯体不适的症状，严重时可产生自残或自
[1]
乏、意识活动减退、认知功能损害为主要临床表现的精 杀行为 。随着人们生活与工作节奏的加快以及压力的
神障碍性疾病，患者常伴有失眠、食欲不振、胸闷、多汗、 逐步增大，抑郁症的发病率也呈逐年上升态势。据报
道，2012年全球约有3.5亿人患有抑郁症，而我国是抑郁
Δ 基金项目 河南省科技攻关项目（No.212102310588）
＊第一作者 主治医师。研究方向：临床精神病学。电话：0391- 症患者最多的国家，发病率约为6.8%，其中约3.4%为重
6800501。E-mail：Lhuiquan1985@163.com 度抑郁患者 [2―3] 。长期的抑郁情绪会严重影响患者正常

中国药房 2023年第34卷第1期 China Pharmacy 2023 Vol. 34 No. 1 · 91 ·