학술논문
二甲双胍治疗奥氮平所致精神分裂症患者体质量增加的系统评价 / Metformin for olanzapine-induced weight gain in schizophrenia:a systematic review
Document Type
Academic Journal
Author
周惠至; 杨晨; 王少华; 杨润许; 岳伟华; 康传媛; Zhou Huizhi; Yang Chen; Wang Shaohua; Yang Runxu; Yue Weihua; Kang Chuanyuan
Source
中华精神科杂志. 50(1):72-76
Subject
Language
Chinese
ISSN
1006-7884
Abstract
目的：系统评价二甲双胍对使用奥氮平治疗所致精神分裂症患者体质量增加的作用。方法通过检索Cochrane Library、PubMed、荷兰医学文摘数据库(excerpta medica database, EMBASE)、Ovid/Medline、PsycINFO、ISI web of knowledge、中国生物医学文献服务系统、中国知识资源总库、万方数据库及中国科技期刊数据库2015年12月31日之前刊登的所有文献，收集有关二甲双胍治疗精神分裂症患者因使用奥氮平所致体质量增加的研究。采用Review Manager 5.3软件进行统计学分析。按照Cochrane系统评价员学习手册进行Meta分析。结果纳入12篇文献共11项研究，由于纳入研究起始服用二甲双胍的时间不同，以及试验设计不同，无法汇集结果进行Meta分析，故对两种类型的研究进行了分组[奥氮平+二甲双胍组（简称二甲双胍组）、单用奥氮平或加安慰剂组（简称对照组）]分析，奥氮平治疗之初使用二甲双胍的5项研究显示：二甲双胍组与对照组治疗终点体质量及BMI均较基线时增加；治疗终点二甲双胍组体质量[均数差（mean difference，MD）：-3.59，95%CI-6.62~-0.57， P=0.020]及BMI（MD：-1.17，95%CI-2.05~-0.29，P=0.009）均小于对照组，差异具有统计学意义。奥氮平治疗3个月以上或体质量增加≥7%后加用二甲双胍的6项研究显示：（1）前后对照：加用二甲双胍后体质量及BMI均较基线减少，2项指标治疗前后的差异均有统计学意义（Z=2.86，P=0.004；Z=3.25，P=0.001）。（2）随机对照研究：二甲双胍组与对照组相比体质量及BMI减少，但2组间仅体质量差异具有统计学意义（MD：-4.30，95%CI-7.19~-1.40，P=0.004)。结论在精神分裂症患者中二甲双胍对控制或降低奥氮平所致体质量增加有一定疗效。
Objective To undertake a systematic review to evaluate the efficacy of metformin on reducing weight gain in schizophrenics taking olanzapine. Methods Articles published before December 31, 2015 were identified by searching the Cochrane Library,PubMed, excerpta medica database(EMBASE), Ovid/Medline,PsycINFO, ISI web of knowledge, SinoMed, China national knowledge infrastructure (CNKI), WanFang data, and VIP Periodical, using the key words metformin, olanzapine, schizophren* and schizophrenia. Statistical analysis were conducted by Review Manager 5.3 software according to Cochrane Handbook for meta analysis. Results A total of 12 articles and 11 studies were identified. It was impossible to pool the data for meta-analytic purposes due to varieties of timing of initiating metformin treatment and different experimental designs. Therefore, targeted studies were divided into two groups for analyses(olanzapine+metformin group (metformin group), olanzapine monotherapy or olanzapine+placebo (control group)). The 5 studies in which metformin treatment was started at the same time as olanzapine:body weight and BMI were both increased in metformin group and control group. However, body weight (mean difference(MD):-3.59, 95%CI-6.62--0.57,P=0.02) and BMI(MD:-1.17,95%CI-2.05--0.29, P=0.009)in metformin group were both lower compared with those of control group at endpoint. The 6 studies in which metformin was added to a regimen after 3 months stable olanzapine treatment or when≥7%weight gain occurred. After adding metformin, body weight and BMI were statistically reduced compared with baseline(Z=2.86,P=0.004;Z=3.25,P=0.001).Compared with control group, metformin group showed lower body weight and BMI, but only difference in body weight between two groups was statistically significant (MD:-4.30,95%CI-7.19--1.40,P=0.004). Conclusion Metformin may have some value in preventing or reducing weight gain during treatment with olanzapine in schizophrenia.
Objective To undertake a systematic review to evaluate the efficacy of metformin on reducing weight gain in schizophrenics taking olanzapine. Methods Articles published before December 31, 2015 were identified by searching the Cochrane Library,PubMed, excerpta medica database(EMBASE), Ovid/Medline,PsycINFO, ISI web of knowledge, SinoMed, China national knowledge infrastructure (CNKI), WanFang data, and VIP Periodical, using the key words metformin, olanzapine, schizophren* and schizophrenia. Statistical analysis were conducted by Review Manager 5.3 software according to Cochrane Handbook for meta analysis. Results A total of 12 articles and 11 studies were identified. It was impossible to pool the data for meta-analytic purposes due to varieties of timing of initiating metformin treatment and different experimental designs. Therefore, targeted studies were divided into two groups for analyses(olanzapine+metformin group (metformin group), olanzapine monotherapy or olanzapine+placebo (control group)). The 5 studies in which metformin treatment was started at the same time as olanzapine:body weight and BMI were both increased in metformin group and control group. However, body weight (mean difference(MD):-3.59, 95%CI-6.62--0.57,P=0.02) and BMI(MD:-1.17,95%CI-2.05--0.29, P=0.009)in metformin group were both lower compared with those of control group at endpoint. The 6 studies in which metformin was added to a regimen after 3 months stable olanzapine treatment or when≥7%weight gain occurred. After adding metformin, body weight and BMI were statistically reduced compared with baseline(Z=2.86,P=0.004;Z=3.25,P=0.001).Compared with control group, metformin group showed lower body weight and BMI, but only difference in body weight between two groups was statistically significant (MD:-4.30,95%CI-7.19--1.40,P=0.004). Conclusion Metformin may have some value in preventing or reducing weight gain during treatment with olanzapine in schizophrenia.