摘要：

目的 对拉莫三嗪添加治疗癫痫合并抑郁障碍的疗效进行系统评价。方法 以拉莫三嗪（lamotrigine）、癫痫（epilepsy）、抑郁（depressive）等中英文词汇，计算机检索1998 年1 月-2014 年6 月美国国立医学图书馆生物医学信息检索系统、Cochrane 临床对照试验中心注册库、中国知网中国知识基础设施工程、万方数据库等关于拉莫三嗪添加治疗癫痫合并抑郁障碍的临床研究，分别以Cochrane 系统评价手册5.0.2 随机对照试验质量评价标准和RevMan 5.1.1 统计软件行文献质量评价和Meta 分析。结果 经剔除重复和不符合纳入标准文献，48 篇文献中最终仅纳入3 项临床试验共668 例癫痫合并抑郁障碍患者。Meta 分析显示：拉莫三嗪组患者Beck 抑郁量表第2 版（MD = - 8.400，95%CI：- 10.890 ~ - 5.920；P = 0.000）、康奈尔精神抑郁量表（MD = - 8.240，95%CI：- 11.180 ~ - 5.290；P = 0.000）以及简明心境量表（MD = - 24.210，95%CI：- 30.740 ~ - 17.680；P = 0.000）评分改善程度均优于对照组；POMS 量表6 项分量表评分中拉莫三嗪组患者紧张-焦虑（MD = - 3.360，95%CI：- 4.620 ~ - 2.100；P = 0.000）、抑郁-沮丧（MD = - 5.490，95%CI：- 7.420 ~ - 3.560；P = 0.000）、愤怒-敌意（MD = -3.870，95%CI：- 5.510 ~ - 2.230；P = 0.000）、疲乏-迟钝（MD = - 4.480，95%CI：- 5.630 ~ - 3.320；P = 0.000）、迷惑-混乱（MD = - 2.720，95%CI：- 3.730 ~ - 1.720；P = 0.000）评分均低于对照组，而精力-活力评分高于对照组（MD = 3.970，95%CI：2.870 ~ 5.070；P = 0.000）。结论 拉莫三嗪添加治疗癫痫合并抑郁障碍疗效良好，主要不良反应为皮疹、中枢神经系统兴奋等。

关键词: 三嗪类, 癫痫, 抑郁, Meta分析

Abstract:

Objective To evaluate the efficacy of adjunctive lamotrigine in the treatment of patients with epilepsy and comorbid depressive symptoms. Methods Relevant clinical trials were searched via PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI) and Wanfang Data from January 1998 to June 2014 using the following retrieval words: lamotrigine, epilepsy and depressive both in Chinese and English. The Cochrane Handbook for Systematic Reviews of Interventions (Version 5.0.2) was used to evaluate the quality of randomized controlled trials (RCTs). Two reviewers independently evaluated the quality of included articles and abstracted the data. Meta-analysis was conducted using RevMan 5.1.1 software. Results According to the inclusion criteria, 3 prospective clinical trials with a total of 668 patients were finally selected. The Meta-analysis showed the Beck Depression Inventory-Ⅱ (BDI-Ⅱ) score (MD = - 8.400, 95%CI: - 10.890— - 5.920; P = 0.000), Cornell Dysthymia Rating Scale (CDRS) score (MD = - 8.240, 95% CI: - 11.180— - 5.290; P = 0.000) and Profile of Mood States (POMS) score (MD = - 24.210, 95%CI: - 30.740— - 17.680; P = 0.000) in lamotrigine group were significantly improved compared to those in control group. As for 6 mood states in POMS, the scores of tension-anxiety (MD = - 3.360, 95%CI: - 4.620— - 2.100; P = 0.000), depression-dejection (MD = - 5.490, 95%CI: - 7.420— - 3.560; P = 0.000), anger-hostility (MD = - 3.870, 95%CI: - 5.510— - 2.230; P = 0.000), fatigue-inertia (MD = - 4.480, 95%CI: - 5.630— - 3.320; P = 0.000), confusion-bewilderment (MD = - 2.720, 95%CI: - 3.730— - 1.720; P = 0.000) in lamotrigine group were all significantly lower than those in control group, while the score of vigor-activity (MD = 3.970, 95% CI: 2.870-5.070; P = 0.000) was significantly higher than that in control group. Conclusions The effect of adjunctive lamotrigine in the treatment of patients with epilepsy and depression is favorable. The most common side effects include rash and stimulation of central nervous system.

Key words: Triazines, Epilepsy, Depression, Meta-analysis