高血压伴焦虑抑郁患者合并用药的Meta分析

发布时间：2018-12-07 10:16

【摘要】：目的:了解高血压患者伴焦虑、抑郁合并用药的降压疗效,探讨更佳的治疗方案。方法:系统检索Pubmed,CNKI,万方数据库,中国生物医学文献数据库以及Internet 2008-2017年间发表的文献。检索词为高血压,焦虑,抑郁,降压药物,抗焦虑药物,抗抑郁药物(主题词与自由词组合)。采用Jadad法对各研究进行质量评价,利用Meta分析文献中对高血压病伴发焦虑、抑郁患者,应用降压药联合抗焦虑、抗抑郁治疗的降压效果,观察指标为两组治疗后降压有效例数,两组治疗后收缩压及舒张压变化。效应指标分别采用比值比(Odds Ratio,OR),加权均数差(Weighted Mean Difference,WMD)WMD,95%可信区间(CI)统计合并效应量,计算I2进行异质性检验,亚组分析,敏感性分析,评估发表偏倚。结果:共收集到相关文献643篇,符合纳入标准的研究为28篇,研究总计2388例患者。18项研究纳入的患者诊断为高血压合并混合型焦虑抑郁障碍,9项研究的研究对象为高血压合并抑郁障碍患者,入选患者诊断为高血压伴发焦虑障碍研究只有1个。其中17项研究统计了试验组与对照组治疗后降压有效例数,总有效例数合并的OR值为4.41[95%CI3.30～5.89],P0.00001;21项研究对比了两组患者治疗前后的收缩压及舒张压,收缩压合并的加权均数差(WMD)为-12.64[95%CI-15.14～-10.14],舒张压合并的加权均数差(WMD)为-8.78[95%CI-11.51～-6.04],P值均小于 0.00001。结论:降压药物联合抗焦虑、抗抑郁治疗高血压伴焦虑、抑郁患者的疗效总体上明显高于单独降压药物治疗组。
[Abstract]:Objective: to investigate the antihypertensive effect of anxiety and depression in patients with hypertension. Methods: Pubmed,CNKI, Wanfang database, Chinese biomedical literature database and Internet published from 2008 to 2017 were searched systematically. The key words are hypertension, anxiety, depression, antihypertensive drugs, antianxiety drugs and antidepressants (combination of subject words and free words). Jadad method was used to evaluate the quality of each study. The antihypertensive effect of antihypertensive drugs combined with antianxiety and antidepressant treatment was evaluated by Meta analysis literature for patients with hypertension associated with anxiety and depression. The observed indexes were the effective cases of hypotension after treatment in the two groups. Systolic and diastolic blood pressure changes after treatment in both groups. Ratio (Odds Ratio,OR), weighted mean difference (Weighted Mean Difference,WMD), WMD,95% confidence interval (CI) (CI) were used to calculate I2 for heterogeneity test, subgroup analysis and sensitivity analysis. Evaluation of publication bias. Results: a total of 643 articles were collected, 28 of which met the inclusion criteria. A total of 2388 patients were included in the study. The 18 subjects were diagnosed as hypertension with mixed anxiety and depression. Nine studies were conducted in patients with hypertension and depression, and only one patient was selected to be diagnosed as hypertension with anxiety disorder. Among them, 17 studies counted the effective cases of hypotension after treatment in the test group and the control group, the OR value of the total effective cases combined with the total effective cases was 4.41 [95%CI3.30~5.89], P 0.00001; 21 studies compared systolic and diastolic blood pressure before and after treatment. The weighted mean difference (WMD) of systolic blood pressure combined with systolic blood pressure was -12.64 [95%CI-15.14~-10.14]. The weighted mean difference (WMD) of the combined diastolic blood pressure was -8.78 [95%CI-11.51~-6.04], P < 0.00001. Conclusion: the efficacy of antihypertensive drugs combined with antianxiety and antidepressant therapy in patients with hypertension and anxiety is significantly higher than that in patients treated with antihypertensive drugs alone.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1;R749

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