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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Early Selective Serotonin Reuptake Inhibitors for Recovery after Stroke: A Meta-Analysis and Trial Sequential Analysis
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Early Selective Serotonin Reuptake Inhibitors for Recovery after Stroke: A Meta-Analysis and Trial Sequential Analysis

机译：早期选择性血清素再摄取抑制剂进行中风后恢复：Meta分析和试验顺序分析

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Background: Potential benefits and risks of early (= 30 days from stroke onset) selective serotonin reuptake inhibitors (SSRIs) treatment for neurologic functional recovery after stroke are not fully understood. Methods: We searched PubMed, Embase, and the Cochrane Library to identify randomized controlled trials that assessed SSRI medications during the initial ictus after stroke versus placebo. Primary outcome was decrease in National Institutes of Health Stroke Scale (NIHSS) score. Secondary outcomes included the improvement of Barthel index, functional independence (modified Rankin Scale score 0-2 at the end of follow-up), the incidence of depression, and adverse events including diarrhea, insomnia, hepatic enzyme disorders, seizure, and intracranial hemorrhage. We used fixed effects models or random effects models to estimate weighted mean differences (WMDs) and relative risks (RRs) with 95% confidence intervals (CIs) according to heterogeneity. Results: Eight trials were included, with 1549 patients. Compared with placebo, decrease in NIHSS was greater in SSRI-treated patients (WMD, 0.82; 95% CI, 0.31-1.33; P =.002). Trial sequential analysis showed that the cumulative z curve crossed the trial sequential monitoring boundary for benefit, establishing sufficient and conclusive evidence. Early SSRI treatment also promoted Barthel index (WMD, 5.32; 95% CI, 1.65-8.99; P =.005) and functional independence (RR, 2.54; 95% CI, 1.82-3.55; P .0001). There was no difference in the incidence of depression and adverse events between groups. No evidence of publication bias was detected. Conclusions: The early SSRIs treatment reduces the defective neurologic function in patients undergoing rehabilitation after stroke. (c) 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.
机译：背景：对于卒中后神经功能恢复的早期（中风发病后30天）选择性5-羟色胺再摄取抑制剂（SSRIs）治疗的潜在益处和风险尚不完全清楚。方法：我们搜索了PubMed、Embase和Cochrane图书馆，以确定随机对照试验，这些试验评估了卒中后初始发作期间SSRI药物与安慰剂的疗效。主要结果是美国国立卫生研究院卒中量表（NIHSS）评分下降。次要结果包括Barthel指数的改善、功能独立性（随访结束时改良的Rankin量表评分0-2）、抑郁的发生率以及不良事件，包括腹泻、失眠、肝酶紊乱、癫痫和颅内出血。我们使用固定效应模型或随机效应模型，根据异质性以95%置信区间（CI）估计加权平均差（WMD）和相对风险（RRs）。结果：包括8项试验，共1549名患者。与安慰剂相比，SSRI治疗患者的NIHSS下降幅度更大（WMD，0.82；95%可信区间，0.31-1.33；P=0.002）。试验序贯分析显示，累积z曲线越过试验序贯监测边界，从而获得了充分和确凿的证据。早期SSRI治疗也促进了Barthel指数（WMD，5.32；95%可信区间，1.65-8.99；P=.005）和功能独立性（RR，2.54；95%可信区间，1.82-3.55；P；.0001）。两组之间抑郁和不良事件的发生率没有差异。没有发现发表偏倚的证据。结论：早期SSRIs治疗可减少中风后康复患者的神经功能缺陷。（c） 2018年全国中风协会。爱思唯尔公司出版。版权所有。

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