中药治疗抗精神病药物导致肥胖的系统评价和Meta分析-现代医学

中药治疗抗精神病药物导致肥胖的系统评价和Meta分析

单位：1. 北京中医药大学岐黄学院, 北京 100029;
2. 北京中医药大学第三附属医院呼吸科, 北京 100029;
3. 北京中医药大学生命科学学院, 北京 100029;
4. 中国中医科学院西苑医院重症医学科, 北京 100091;
5. 北京中医药大学国家体质与治未病研究院, 北京 100029

关键词：精神分裂症|肥胖|抗精神病药物|中药|Meta分析

分类号：R749.3

出版年·卷·期（页码）：2025·53·第四期（530-539）

摘要：

目的： 评价中药治疗抗精神病药物导致肥胖的临床疗效。方法： 于2024年7月21日，计算机检索知网、万方、维普、中国生物医学文献数据库、PubMed、Cochrane Library、Embase、Web of Science共8个数据库，获取相关文献。由2名研究人员独立筛选文献并提取数据，采用Cochrane Collaboration“RoB2.0”工具对纳入的随机对照试验进行质量评价，使用RevMan 5.4软件进行Meta分析。结果： 共纳入17项随机对照试验，总样本量为1 545例(中药治疗组870例，对照组675例，20例中途退出)。Meta分析结果显示，相比于其他治疗措施，中药能改善患者体重(MD=-4.55，95%CI-7.53~-1.56，P=0.003)、BMI (MD=-1.97，95%CI-3.42~-0.53，P=0.008)和甘油三酯(MD=-0.33，95%CI-0.64~-0.02，P=0.03)。亚组分析显示，中药相比常规空白改善体重(MD=-7.68，95%CI-11.07~-4.29，P＜0.01)和BMI (MD=-3.55，95%CI-4.25~-2.84)，P＜0.01)的疗效更为显著，相比西药升高高密度脂蛋白胆固醇(MD=0.12，95%CI 0.02~0.22，P=0.02)优势明显。结论： 中药可能有助于改善抗精神病药物所致精神分裂症患者肥胖的临床症状，调整脂肪代谢水平。

Objective: To evaluate the clinical efficacy of traditional Chinese medicine(TCM) in the treatment of antipsychotic drugs-induced obesity. Methods: China National Knowledge Infrastructure, Wanfang database, VIP database, Chinese Biomedical Literature Database, PubMed, Embase, Web of Science and Cochrane Library were searched on July 21, 2024. Literature was screened and data extracted independently by two researchers. The Cochrane Collaboration “RoB2.0” tool was used to evaluate the quality of the included randomized controlled trials, and Meta-analysis was performed using RevMan 5.4 software. Results: Seventeen randomized controlled trials were included in this study, with a total sample size of 1 545 patients(870 in the trial group, 675 in the control group, and 20 dropouts). The results of the Meta-analysis showed that compared with the control group, the TCM group improved body weight(MD=-4.55, 95% CI-7.53- -1.56, P=0.003］, body mass index(BMI)(MD=-1.97, 95% CI:-3.42- -0.53, P=0.008), Triglyceride(MD=-0.33, 95% CI-0.64- -0.02, P=0.03). Subgroup analyses revealed that the efficacy of TCM in reducing body weight(MD=-7.68, 95% CI-11.07- -4.29, P＜0.01) and BMI(MD=-3.55, 95% CI-4.25- -2.84, P＜0.01) was more significant than that of conventional blanks, and the advantage of elevating the HDL-C(MD=0.12，95% CI 0.02-0.22，P=0.02) was significant compared to western drugs.Conclusion: TCM may help to improve clinical symptoms of obesity and regulate fat metabolism levels in schizophrenic patients with antipsychotic drug-induced obesity.

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