黄连素对精神分裂症患者血脂水平影响的Meta分析
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摘要
目的系统评价黄连素对精神分裂症患者血脂水平的影响,为精神分裂症患者血脂干预方案的选择提供参考。方法系统检索英文数据库(PubMed、PsycINFO、Embase、Cochrane Library)和中文数据库(中国期刊全文数据库、万方数据库),纳入关于黄连素对精神分裂症患者血脂水平影响的随机对照研究(RCT)。由两位研究者独立进行文献筛选、数据提取和方法学质量评价,采用RevMan 5.3进行Meta分析。结果共纳入3篇RCT,包括207例精神分裂症患者,其中黄连素组103例,对照组104例。Meta分析结果显示,黄连素组的甘油三脂水平低于对照组(WMD=-0.54,95%CI:-0.75～-0.33),差异有统计学意义(P<0.01);黄连素组胆固醇水平低于对照组(WMD=-0.48,95%CI:-0.67～-0.29),差异有统计学意义(P<0.01);黄连素组低密度脂蛋白胆固醇水平低于对照组(WMD=-0.56,95%CI:-0.74～-0.38),差异有统计学意义(P<0.01);黄连素组高密度脂蛋白胆固醇水平高于对照组(WMD=0.06,95%CI:0.02～0.10),差异有统计学意义(P<0.01)。结论黄连素联合抗精神病药物可改善精神分裂症患者的血脂水平,调控脂肪代谢。
Objective To systematically evaluate the effect of berberine on blood lipids levels in patients with schizophrenia, so as to provide references for the intervention program of blood lipid in patients with schizophrenia.Methods Randomized controlled clinical trials(RCTs) in English databases(PubMed, PsycINFO, Embase, Cochrane library) and Chinese databases(CNKI, Wanfang) were retrieved. The literature screening, data extraction and quality assessment were independently completed by two researchers. RevMan 5.3 was used for Meta-analysis. Results A total of 3 RCTs(n=207) were included, including 103 patients in the berberine group and 104 patients in the control group. Meta-analysis showed that the blood triglyceride level in the berberine group was lower than that in the control group(WMD=-0.54, 95% CI:-0.75～-0.33), with statistic difference(P<0.01). The cholesterol level of the berberine group was lower than that of the control group(WMD=-0.48, 95% CI:-0.67～-0.29), with statistic difference(P<0.01).The low-density lipoprotein cholesterol level of the berberine group was lower than the control group(WMD=-0.56, 95% CI:-0.74～-0.38), with statistic difference(P<0.01).The high-density lipoprotein cholesterol level in the berberine group was higher than that in the control group(WMD=0.06, 95% CI: 0.02～0.10), with statistic difference(P<0.01).Conclusion The application of berberine combined with antipsychotic drugs can effectively ameliorate the blood lipids levels as well as regulate fat metabolism in patients with schizophrenia.
Objective To systematically evaluate the effect of berberine on blood lipids levels in patients with schizophrenia, so as to provide references for the intervention program of blood lipid in patients with schizophrenia.Methods Randomized controlled clinical trials(RCTs) in English databases(PubMed, PsycINFO, Embase, Cochrane library) and Chinese databases(CNKI, Wanfang) were retrieved. The literature screening, data extraction and quality assessment were independently completed by two researchers. RevMan 5.3 was used for Meta-analysis. Results A total of 3 RCTs(n=207) were included, including 103 patients in the berberine group and 104 patients in the control group. Meta-analysis showed that the blood triglyceride level in the berberine group was lower than that in the control group(WMD=-0.54, 95% CI:-0.75～-0.33), with statistic difference(P<0.01). The cholesterol level of the berberine group was lower than that of the control group(WMD=-0.48, 95% CI:-0.67～-0.29), with statistic difference(P<0.01).The low-density lipoprotein cholesterol level of the berberine group was lower than the control group(WMD=-0.56, 95% CI:-0.74～-0.38), with statistic difference(P<0.01).The high-density lipoprotein cholesterol level in the berberine group was higher than that in the control group(WMD=0.06, 95% CI: 0.02～0.10), with statistic difference(P<0.01).Conclusion The application of berberine combined with antipsychotic drugs can effectively ameliorate the blood lipids levels as well as regulate fat metabolism in patients with schizophrenia.
引文
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[9] Thakurathi N,Stock S,Oppenheim CE,et al.Open-label pilot study on vitamin D3 supplementation for antipsychotic-associated metabolic anomalies[J].Int Clin Psychopharmacol,2013,28(5):275-282.
[10] 纪家武,蒋昕,陈华云,等.奥氮平联合金刚烷胺治疗精神分裂症首次发病患者的随机双盲对照研究[J].临床精神医学杂志,2014,24(1):1-3.
[11] Haddad PM,Sharma SG.Adverse effects of atypical antipsychotics:differential risk and clinical implications[J].CNS Drugs,2007,21(11):911-936.
[12] 江焱.黄连素对代谢综合征胰岛素敏感性的影响[J].浙江中医药大学学报,2009,33(3):390,393.
[13] Huang XS,Yang GF,Pan YC.Effect of berberin hydrochloride on blood concentration of cyclosporine A in cardiac transplanted recipients[J].Zhongguo Zhong Xi Yi Jie He Za Zhi,2008,28(8):702-704.
[14] Costa MM.Videofluoroscopy:the gold standard exam for studying swallowing and its dysfunction[J].Arq Gastroenterol,2010,47(4):327-328.
[15] 李美娟.黄连素和生活干预治疗精神分裂症患者代谢综合征的对照研究[D].天津:天津医科大学,2016.
[16] 李美娟,李洁,刘莹,等.盐酸小檗碱对精神分裂症患者糖脂代谢的影响[J].中国慢性病预防与控制,2016,24(4):262-265.
[17] 刘莹.黄连素合并利培酮对精神分裂症患者糖脂代谢及认知功能影响的研究[D].天津:天津医科大学,2015.
[18] Smith RC,Lindenmayer JP,Bark N,et al.Clozapine,risperidone,olanzapine,and conventional antipsychotic drug effects on glucose,lipids,and leptin in schizophrenic patients[J].Int J Neuropsychopharmacol,2005,8(2):183-194.
[19] Bresee LC,Majumdar SR,Patten SB,et al.Utilization of general and specialized cardiac care by people with schizophrenia[J].Psychiatr Serv,2012,63(3):237-242.
[20] 周中华.精神分裂症患者心血管疾病风险因素临床分析[J].湖北科技学院学报(医学版),2018,32(5):393-395.
[21] Scigliano G,Ronchetti G.Antipsychotic-induced metabolic and cardiovascular side effects in schizophrenia:a novel mechanistic hypothesis[J].CNS Drugs,2013,27(4):249-257.
[22] Dong H,Zhao Y,Zhao L,et al.The effects of berberine on blood lipids:a systemic review and meta-analysis of randomized controlled trials[J].Planta Med,2013,79(6):437-446.
[23] Dong B,Li H,Singh AB,et al.Inhibition of PCSK9 transcription by berberine involves down-regulation of hepatic HNF1α protein expression through the ubiquitin-proteasome degradation pathway[J].J Biol Chem,2015,290(7):4047-4058.
[24] Kong W,Wei J,Abidi P,et al.Berberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins[J].Nat Med,2004,10(12):1344-1351.
[25] Zheng W,Xiang YT,Xiang YQ,et al.Efficacy and safety of adjunctive topiramate for schizophrenia:a meta-analysis of randomized controlled trials[J].Acta Psychiatr Scand,2016,134(5):385-398.
[26] Zheng W,Li XB,Tang YL,et al.Metformin for weight gain and metabolic abnormalities associated with antipsychotic treatment:meta-analysis of randomized placebo-controlled trials[J].J Clin Psychopharmacol,2015,35(5):499-509.
[27] 李建功.小檗碱与二甲双胍对精神分裂症伴发代谢综合征的疗效与安全性对照研究[D].天津:天津医科大学,2017.
[28] 姚雪.心脑血管病诊治中血脂检验的临床运用研究[J].临床医学研究与实践,2016,1(15):51.
[29] 韩宁,向湘元,韩春俐.血脂检验在心脑血管病诊治中的临床应用价值及对ApoA-1水平的影响[J].临床检验杂志(电子版),2019,8(1):113.
[2] 杭荣华,李业平,吴明飞,等.门诊精神分裂症患者药物治疗的依从性与不良反应、社会支持的关系[J].中国临床药理学与治疗学,2014,19(8):912-915.
[3] 马玉娟,鲁陆,邓永宜.门诊精神分裂症患者服药依从性的相关因素研究[J].检验医学与临床,2017,14(16):2405-2407.
[4] Gilmer TP,Dolder CR,Lacro JP,et al.Adherence to treatment with antipsychotic medication and health care costs among medicaid beneficiaries with schizophrenia[J].Am J Psychiatry,2004,161(4):692-699.
[5] Laursen TM,Nordentoft M,Mortensen PB.Excess early mortality in schizophrenia[J].Annu Rev Clin Psychol,2014,10:425-448.
[6] Gon?alves P,Araújo JR,Martel F.Antipsychotics-induced metabolic alterations:focus on adipose tissue and molecular mechanisms[J].Eur Neuropsychopharmacol,2015,25(1):1-16.
[7] Yan H,Chen JD,Zheng XY.Potential mechanisms of atypical antipsychotic-induced hypertriglyceridemia[J].Psychopharmacology (Berl),2013,229(1):1-7.
[8] Taveira TH,Wu WC,Tschibelu E,et al.The effect of naltrexone on body fat mass in olanzapine-treated schizophrenic or schizo-affective patients:a randomized double-blind placebo-controlled pilot study[J].J Psychopharmacol,2014,28(4):395-400.
[9] Thakurathi N,Stock S,Oppenheim CE,et al.Open-label pilot study on vitamin D3 supplementation for antipsychotic-associated metabolic anomalies[J].Int Clin Psychopharmacol,2013,28(5):275-282.
[10] 纪家武,蒋昕,陈华云,等.奥氮平联合金刚烷胺治疗精神分裂症首次发病患者的随机双盲对照研究[J].临床精神医学杂志,2014,24(1):1-3.
[11] Haddad PM,Sharma SG.Adverse effects of atypical antipsychotics:differential risk and clinical implications[J].CNS Drugs,2007,21(11):911-936.
[12] 江焱.黄连素对代谢综合征胰岛素敏感性的影响[J].浙江中医药大学学报,2009,33(3):390,393.
[13] Huang XS,Yang GF,Pan YC.Effect of berberin hydrochloride on blood concentration of cyclosporine A in cardiac transplanted recipients[J].Zhongguo Zhong Xi Yi Jie He Za Zhi,2008,28(8):702-704.
[14] Costa MM.Videofluoroscopy:the gold standard exam for studying swallowing and its dysfunction[J].Arq Gastroenterol,2010,47(4):327-328.
[15] 李美娟.黄连素和生活干预治疗精神分裂症患者代谢综合征的对照研究[D].天津:天津医科大学,2016.
[16] 李美娟,李洁,刘莹,等.盐酸小檗碱对精神分裂症患者糖脂代谢的影响[J].中国慢性病预防与控制,2016,24(4):262-265.
[17] 刘莹.黄连素合并利培酮对精神分裂症患者糖脂代谢及认知功能影响的研究[D].天津:天津医科大学,2015.
[18] Smith RC,Lindenmayer JP,Bark N,et al.Clozapine,risperidone,olanzapine,and conventional antipsychotic drug effects on glucose,lipids,and leptin in schizophrenic patients[J].Int J Neuropsychopharmacol,2005,8(2):183-194.
[19] Bresee LC,Majumdar SR,Patten SB,et al.Utilization of general and specialized cardiac care by people with schizophrenia[J].Psychiatr Serv,2012,63(3):237-242.
[20] 周中华.精神分裂症患者心血管疾病风险因素临床分析[J].湖北科技学院学报(医学版),2018,32(5):393-395.
[21] Scigliano G,Ronchetti G.Antipsychotic-induced metabolic and cardiovascular side effects in schizophrenia:a novel mechanistic hypothesis[J].CNS Drugs,2013,27(4):249-257.
[22] Dong H,Zhao Y,Zhao L,et al.The effects of berberine on blood lipids:a systemic review and meta-analysis of randomized controlled trials[J].Planta Med,2013,79(6):437-446.
[23] Dong B,Li H,Singh AB,et al.Inhibition of PCSK9 transcription by berberine involves down-regulation of hepatic HNF1α protein expression through the ubiquitin-proteasome degradation pathway[J].J Biol Chem,2015,290(7):4047-4058.
[24] Kong W,Wei J,Abidi P,et al.Berberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins[J].Nat Med,2004,10(12):1344-1351.
[25] Zheng W,Xiang YT,Xiang YQ,et al.Efficacy and safety of adjunctive topiramate for schizophrenia:a meta-analysis of randomized controlled trials[J].Acta Psychiatr Scand,2016,134(5):385-398.
[26] Zheng W,Li XB,Tang YL,et al.Metformin for weight gain and metabolic abnormalities associated with antipsychotic treatment:meta-analysis of randomized placebo-controlled trials[J].J Clin Psychopharmacol,2015,35(5):499-509.
[27] 李建功.小檗碱与二甲双胍对精神分裂症伴发代谢综合征的疗效与安全性对照研究[D].天津:天津医科大学,2017.
[28] 姚雪.心脑血管病诊治中血脂检验的临床运用研究[J].临床医学研究与实践,2016,1(15):51.
[29] 韩宁,向湘元,韩春俐.血脂检验在心脑血管病诊治中的临床应用价值及对ApoA-1水平的影响[J].临床检验杂志(电子版),2019,8(1):113.