上海精神医学
上海精神醫學
상해정신의학
SHANGHAI ARCHIVES OF PSYCHIATRY
2014年
5期
248-258
,共11页
李伟%万玉美%任娟娟%李婷%李春波
李偉%萬玉美%任娟娟%李婷%李春波
리위%만옥미%임연연%리정%리춘파
系统综述%方法学质量%AMSTAR%选择性5-羟色胺能再摄取抑制剂%自杀意念%自杀行为
繫統綜述%方法學質量%AMSTAR%選擇性5-羥色胺能再攝取抑製劑%自殺意唸%自殺行為
계통종술%방법학질량%AMSTAR%선택성5-간색알능재섭취억제제%자살의념%자살행위
systematic reviews%methodological quality%AMSTAR%selective serotonin reuptake inhibitors%suicidal ideaiton%suicidal behavior
背景：关于使用选择性5-羟色胺再摄取抑制剂（SSRIs）与自杀意念或行为的关系，一些系统综述已发表，但是对这些报告的质量并没有做过正式的评估。
<br> 目的：评估有关使用SSRI与自杀意念和行为之间关系的系统综述的方法学质量；并提供在此评估的基础上得出的总体结论。
<br> 方法：通过检索Pubmed, Embase，Cochrane图书馆， EBSCO，PsycINFO，中国国家知网，中国科技期刊重庆维普数据库，万方数据库，和中国生物医学文献数据库来确定相关的系统综述，这些系统综述纳入了比较SSRI类药物与安慰剂、以自杀意念或行为作为关键变量的随机对照试验。两个专家评估者独自采用多系统综述11项评估量表（AMSTAR）对纳入评估的文献进行方法学质量的评估。
<br> 结果：共检出12篇系统综述和meta分析。AMSTAR总体质量评分的评分者信度非常好（ICC=0.86），但11个AMSTAR项目中有5项的评分者信度较差（Kappa
<br> 值<0.60）。根据AMSTAR总分，仅1篇为高质量等级，8篇为中等质量等级，3篇为低质量等级。这篇高质量综述和3篇中等质量的综述均报告SSRI组中自杀意念或行为的风险显著高于安慰剂组。4篇仅限于儿童和青少年的综述中有3篇报道服用帕罗西汀和患有抑郁症的青少年有显著增加自杀意念或行为的风险。
<br> 结论：现有证据表明，青少年使用SSRI类药物可能会增加自杀意念和行为的风险，尤其是抑郁症患者和服用帕罗西汀的患者。但是，相关高质量的综述很少，所以对这一结论还存有疑问。AMSTAR量表对于提高系统综述质量也许是有用的，但对量表中的某些项目需要严格操作标准。
揹景：關于使用選擇性5-羥色胺再攝取抑製劑（SSRIs）與自殺意唸或行為的關繫，一些繫統綜述已髮錶，但是對這些報告的質量併沒有做過正式的評估。
<br> 目的：評估有關使用SSRI與自殺意唸和行為之間關繫的繫統綜述的方法學質量；併提供在此評估的基礎上得齣的總體結論。
<br> 方法：通過檢索Pubmed, Embase，Cochrane圖書館， EBSCO，PsycINFO，中國國傢知網，中國科技期刊重慶維普數據庫，萬方數據庫，和中國生物醫學文獻數據庫來確定相關的繫統綜述，這些繫統綜述納入瞭比較SSRI類藥物與安慰劑、以自殺意唸或行為作為關鍵變量的隨機對照試驗。兩箇專傢評估者獨自採用多繫統綜述11項評估量錶（AMSTAR）對納入評估的文獻進行方法學質量的評估。
<br> 結果：共檢齣12篇繫統綜述和meta分析。AMSTAR總體質量評分的評分者信度非常好（ICC=0.86），但11箇AMSTAR項目中有5項的評分者信度較差（Kappa
<br> 值<0.60）。根據AMSTAR總分，僅1篇為高質量等級，8篇為中等質量等級，3篇為低質量等級。這篇高質量綜述和3篇中等質量的綜述均報告SSRI組中自殺意唸或行為的風險顯著高于安慰劑組。4篇僅限于兒童和青少年的綜述中有3篇報道服用帕囉西汀和患有抑鬱癥的青少年有顯著增加自殺意唸或行為的風險。
<br> 結論：現有證據錶明，青少年使用SSRI類藥物可能會增加自殺意唸和行為的風險，尤其是抑鬱癥患者和服用帕囉西汀的患者。但是，相關高質量的綜述很少，所以對這一結論還存有疑問。AMSTAR量錶對于提高繫統綜述質量也許是有用的，但對量錶中的某些項目需要嚴格操作標準。
배경：관우사용선택성5-간색알재섭취억제제（SSRIs）여자살의념혹행위적관계，일사계통종술이발표，단시대저사보고적질량병몰유주과정식적평고。
<br> 목적：평고유관사용SSRI여자살의념화행위지간관계적계통종술적방법학질량；병제공재차평고적기출상득출적총체결론。
<br> 방법：통과검색Pubmed, Embase，Cochrane도서관， EBSCO，PsycINFO，중국국가지망，중국과기기간중경유보수거고，만방수거고，화중국생물의학문헌수거고래학정상관적계통종술，저사계통종술납입료비교SSRI류약물여안위제、이자살의념혹행위작위관건변량적수궤대조시험。량개전가평고자독자채용다계통종술11항평고량표（AMSTAR）대납입평고적문헌진행방법학질량적평고。
<br> 결과：공검출12편계통종술화meta분석。AMSTAR총체질량평분적평분자신도비상호（ICC=0.86），단11개AMSTAR항목중유5항적평분자신도교차（Kappa
<br> 치<0.60）。근거AMSTAR총분，부1편위고질량등급，8편위중등질량등급，3편위저질량등급。저편고질량종술화3편중등질량적종술균보고SSRI조중자살의념혹행위적풍험현저고우안위제조。4편부한우인동화청소년적종술중유3편보도복용파라서정화환유억욱증적청소년유현저증가자살의념혹행위적풍험。
<br> 결론：현유증거표명，청소년사용SSRI류약물가능회증가자살의념화행위적풍험，우기시억욱증환자화복용파라서정적환자。단시，상관고질량적종술흔소，소이대저일결론환존유의문。AMSTAR량표대우제고계통종술질량야허시유용적，단대량표중적모사항목수요엄격조작표준。
Background:Several systemaitc reviews have been published about the relaitonship of the use of selecitve serotonin reuptake inhibitors (SSRIs) and risk of suicidal ideaiton or behavior but there has been no formal assessment of the quality of these reports.
<br> Aim:Assess the methodological quality of systemaitc reviews about the relaitonship of SSRI use and suicidal ideaiton and behavior;and provide overall conclusions based on this assessment.
<br> Methods:Systemaitc reviews of RCTs that compared SSRIs to placebo and used suicidal ideaiton or behavior as a key outcome variable were identified by searching Pubmed, Embase, The Cochrane Library, EBSCO, PsycINFO, Chinese National Knowledge Infrastructure, Chongqing VIP database for Chinese Technical Periodicals, WANFANG DATA, and the Chinese Biological Medical Literature Database. The methodological quality of included reviews was independently assessed by two expert raters using the 11-item Assessment of Mulitple Systemaitc Reviews (AMSTAR) scale.
<br> Results:Twelve systematic reviews and meta-analyses were identified. The inter-rater reliability of the overall AMSTAR quality score was excellent (ICC=0.86) but the inter-rater reliability of 5 of the 11 AMSTAR items was poor (Kappa<0.60). Based on the AMSTAR total score, there was one high-quality review, eight moderate-quality reviews, and three low-quality reviews. The high-quality review and three of the moderate-quality reviews reported a significantly increased risk of suicidal ideation or behavior in the SSRI group compared to the placebo group. Three of the four reviews limited to children and adolescents found a signiifcantly increased risk of suicidal ideaiton or behavior with SSRI use which was most evident in teenagers taking paroxeitne and in teenagers with depressive disorders.
<br> Conclusions:The available evidence suggests that adolescents may experience an increase in suicidal ideaiton and behavior with SSRI use, paritcularly those who have a depressive disorder and those treated with paroxetine. However, there are few high-quality reviews on this issue, so some doubt about the evidence remains. The AMSTAR scale may be useful in the ongoing efforts to improve the quality of systemaitc reviews, but further work is needed on itghtening the operaitonal criteria for some of the items in the scale.
