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首页> 外文期刊>Psychosomatic Medicine: Journal of the American Psychosomatic Society >Hybrid Systematic Review and Network Meta-Analysis of Randomized Controlled Trials of Interventions for Depressive Symptoms in Patients With Coronary Artery Disease
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Hybrid Systematic Review and Network Meta-Analysis of Randomized Controlled Trials of Interventions for Depressive Symptoms in Patients With Coronary Artery Disease

机译：冠状动脉疾病患者抑郁症状干预措施的杂交系统综述与网络荟萃分析

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Objective Depression is common in patients with coronary artery disease (CAD) and is associated with poor outcomes. Although different treatments are available, it is unclear which are best or most acceptable to patients, so we conducted a network meta-analysis of evidence from randomized controlled trials (RCTs) of different depression treatments to ascertain relative efficacy. Methods We searched for systematic reviews of RCTs of depression treatments in CAD and updated these with a comprehensive search for recent individual RCTs. RCTs comparing depression treatments (pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) were included. Primary outcomes were acceptability (dropout rate) and change in depressive symptoms 8 week after treatment commencement. Change in 26-week depression and mortality were secondary outcomes. Frequentist, random-effects network meta-analysis was used to synthesize the evidence, and evidence quality was evaluated following Grading of Recommendations, Assessment, Development and Evaluations recommendations. Results Thirty-three RCTs (7240 participants) provided analyzable data. All treatments were equally acceptable. At 8 weeks, combination therapy (1 study), exercise (1 study), and antidepressants (10 studies) yielded the strongest effects versus comparators. At 26 weeks, antidepressants were consistently effective, but psychotherapy was only effective versus usual care. There were no differences in treatment groups for mortality. Grading of Recommendations, Assessment, Development and Evaluations ratings ranged from very low to low. Conclusions Overall, the evidence was limited and biased. Although all treatments for post-CAD depression were equally acceptable, antidepressants have the most robust evidence base and should be the first-line treatment. Combinations of antidepressants and psychotherapy, along with exercise, could be more effective than antidepressants alone but require further rigorous, multiarm intervention trials. Systematic Review Registration: CRD42018108293 (International Prospective Register of Systematic Reviews)
机译：目的抑郁症在冠心病（CAD）患者中很常见，与不良预后相关。虽然有不同的治疗方法，但尚不清楚哪种治疗方法最好或最能被患者接受，因此我们对来自不同抑郁症治疗的随机对照试验（RCT）的证据进行了网络荟萃分析，以确定其相对疗效。方法我们检索了CAD中抑郁症治疗的随机对照试验的系统综述，并通过综合检索近期的个体随机对照试验对其进行了更新。包括比较抑郁症治疗（药理学、心理治疗、药理学/心理治疗结合、运动、协作护理）的随机对照试验。主要结果是治疗开始后8周的可接受性（辍学率）和抑郁症状的变化。26周抑郁症和死亡率的变化是次要结果。使用频繁随机效应网络元分析来综合证据，并根据建议、评估、发展和评估建议的分级来评估证据质量。结果33项随机对照试验（7240名参与者）提供了可分析的数据。所有的治疗都是同样可以接受的。8周时，与对照组相比，联合治疗（1项研究）、运动（1项研究）和抗抑郁药（10项研究）产生的效果最强。在26周时，抗抑郁药物始终有效，但心理治疗仅对常规护理有效。治疗组的死亡率没有差异。建议分级、评估、发展和评价评分从很低到很低不等。结论总体而言，证据有限且存在偏见。虽然所有治疗冠心病后抑郁症的方法都是同样可以接受的，但抗抑郁药物有最可靠的证据基础，应该是一线治疗。抗抑郁药和心理治疗的结合，以及锻炼，可能比单独使用抗抑郁药更有效，但需要进一步严格的多组干预试验。系统评价注册：CRD4201818293（国际前瞻性系统评价注册）

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