哌醋甲酯和托莫西汀治疗注意缺陷多动障碍的疗效与安全性的系统评价

摘要
图/表
参考文献(20)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (965 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的：对中国儿童青少年注意缺陷多动障碍（ADHD）来说, 哌醋甲酯速释片（IR-MPH）、哌醋甲酯控释片（OROS-MPH）和托莫西汀（AHC）等3种药物的疗效、安全性等问题尚存在争议，本研究采用系统综述的方法评价三者治疗中国儿童青少年ADHD的疗效及安全性，为临床用药提供依据。方法：系统检索CNKI、中文科技期刊数据库、CBMDISC网络版、Pubmed、Embase 和 MEDLINE数据库中相关的随机或临床对照研究。由两名评价者独立筛选、摘录文献信息并对纳入文献进行质量评价。结果：共纳入8篇文献。IR-MPH、OROS-MPH和AHC三者对ADHD的疗效确切，OROS-MPH在改善同伴关系、CGI-I评分、母亲满意度、心身问题因子等方面优于IR-MPH。AHC组与IR-MPH组的疗效评分差异无统计学意义。三者不良反应发生率差异无统计学意义,均为轻度不良反应。结论：OROS-MPH可能优于IR-MPH, AHC与IR-MPH 疗效相当。三者的安全性相当,耐受性较好。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	吕晓珍
	舒正
	张耀文
	武珊珊
	詹思延

关键词 ：哌醋甲酯, 托莫西汀, 注意缺陷多动障碍, 系统评价, 儿童

Abstract：OBJECTIVE: To assess and compare the effectiveness and safety of methylphenidate immediate-release tablets (IR-MPH), methylphenidate controlled release tablets (OROS-MPH) and atomoxetine (AHC) for attention deficit hyperactivity disorder (ADHD) in Chinese children. METHODS: Randomized or clinical controlled trials on the effectiveness and safety of IR-MPH, OROS-MPH and AHC for ADHD were searched in electronic databases of CNKI, VIP, CBMDISC online, PubMed, Embase and MEDLINE. Two reviewers independently extracted the data and assessed the quality of the included literatures. RESULTS: Eight trials were finally included. IR-MPH, OROS-MPH and AHC were effective for ADHD. OROS-MPH was superior to IR-MPH in the improvement of peer relationship, CGI-I score, mother satisfaction and psychosomatic problems. There were no significant differences in the effectiveness between the AHC and IR-MPH groups. The adverse events related to the therapy with IR-MPH, OROS-MPH or AHC were mild and the incidence rates of adverse events were not significantly different among the three groups. CONCLUSIONS: The effectiveness of OROS-MPH for the treatment of ADHD is probably superior to IR-MPH, and the effectiveness between AHC and IR-MPH is similar. The three drugs demonstrate the safety and well tolerance.

Key words： Methylphenidate Atomoxetine Attention deficit hyperactivity disorder Systematic review Child

PACS:

R749.94

引用本文:

吕晓珍,舒正,张耀文等. 哌醋甲酯和托莫西汀治疗注意缺陷多动障碍的疗效与安全性的系统评价[J]. 中国当代儿科杂志, 2011, 13(5): 365-369.

LV, Xiao-Zhen,SHU Zheng,ZHANG Yao-Wen et al. Effectiveness and safety of methylphenidate and atomoxetine for attention deficit hyperactivity disorder: a systematic review[J]. CJCP, 2011, 13(5): 365-369.

链接本文:

http://www.zgddek.com/CN/ 或 http://www.zgddek.com/CN/Y2011/V13/I5/365

	［1］王玉凤.儿童多动症已成为重大公共卫生问题［C］.儿科及精神科医生注意缺陷多动障碍国际研讨会.2005,北京：中国卫生部.
	［2］Spencer T, Biederman J, Wilens T. Attention-deficit/hyperactivity disorder and comorbidity［J］. Pediatr Clin North Am, 1999, 46(5): 915-927.
	［3］McGough JJ, McBurnett K, Bukstein O, Wilens TE, Greenhill L, Lerner M, et al. Once-daily OROS methylphenidate is safe and well tolerated in adolescents with attention-deficit/hyperactivity disorder［J］. J Child Adolesc Psychopharmacol, 2006, 16(3): 351-356.
	［4］Kratochvil CJ, Wilens TE, Greenhill LL, Gao H, Baker KD, Feldman PD, et al. Effects of long-term atomoxetine treatment for young children with attention-deficit/hyperactivity disorder［J］. J Am Acad Child Adolesc Psychiatry, 2006, 45(8): 919-927.
	［5］Weiss M, Tannock R, Kratochvil C, Dunn D, Velez-Borras J, Thomason C, et al. A randomized, placebo-controlled study of once-daily atomoxetine in the school setting in children with ADHD［J］. J Am Acad Child Adolesc Psychiatry, 2005, 44(7): 647-655.
	［6］American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder ［M ］. 4 th ed. Washington DC: American Psychiatric Association, 1994: 129-130.
	［7］Gau SS, Shen HY, Soong WT, Gau CS. An open-label, randomized, active-controlled equivalent trial of osmotic release oral system methylphenidate in children with attentiondeficit/hyperactivity disorder in Taiwan［J］. J Child Adolesc Psychopharmacol, 2006,16(4): 441-455.
	［8］卜茹，周宏辉，孙金荣，储昕.两种哌甲酯片治疗多动障碍临床对照研究［J］.临床精神医学杂志，2008，18(6)：381-383.
	［9］江文庆，杜亚松.盐酸哌甲酯控释剂与速释剂对注意缺陷与多动障碍的疗效比较［J］.上海精神医学,2007,19(1):25-27.
	［10］潘学霞，麻宏伟，万彬，戴晓梅.盐酸哌甲酯控释片治疗注意缺陷多动障碍疗效观察［J］. 中国当代儿科杂志,2008,10(4):471-474.
	［11］李飞，苏林雁，刘军，朱焱.盐酸托莫西汀和盐酸哌甲酯治疗注意缺陷多动障碍门诊患儿的随机双盲对照研究［J］.中国神经精神疾病杂志，2006，32(2)：182-184.
	［12］徐通，周翊，魏宏伟，马丽，国献素，颜庭文.托莫西汀和哌甲酯治疗儿童注意缺陷多动障碍的疗效和安全性比较［J］. 中国实用儿科杂志,2008,23(7):499-501.
	［13］占雪梅，周云芳，邹晓华.托莫西汀与利他林治疗儿童多动症的临床对照研究［J］. 临床医药,2009,18(11):71-72.
	［14］丁爱茹，叶菊芬，周云芳.托莫西汀治疗儿童多动症临床疗效分析［J］. 海峡药学, 2009,21(6):121-122.
	［15］Steele M, Weiss M, Swanson J, Jenny W, Prinzo RS, Binder CE.A randomized, controlled effectiveness trial of OROS-methylphenidate compared to usual care with immediate-release methylphenidate in attention deficit-hyperactivity disorder［J］. Can J Clin Pharmacol, 2006,13(1): 50-62.
	［16］徐佩茹，方志敏.阿托莫西汀与哌甲酯治疗儿童注意缺陷多动障碍疗效与安全性的Meta分析［J］.中国循证医学杂志, 2009,9(3): 346-349.
	［17］张玉娟，王玉凤.盐酸托莫西汀治疗共患抽动障碍的注意缺陷多动障碍的临床疗效［J］.实用儿科临床杂志,2009,24(3):220-222.
	［18］Spencer TJ, Sallee FR, Gilbert DL, Dunn DW, McCracken JT, Coffey BJ, et al. Atomoxetine treatment of ADHD in children with comorbid Tourette syndrome［J］. J Atten Disord, 2008,11(4): 470-481.
	［19］Allen AJ, Kulan RM, Gibert DL,Coffey BJ, Linder SL, Lewis DW, et al. Atomoxetine treatment in children and adolescents with ADHD and comorbid tic disorders［J］. Neurology, 2005, 65(12): 1941-1949.
	［20］Geller D, Donnelly C, Lopez F, Rubin R, Newcorn J, Sutton V,et al. Atomoxetine treatment for pediatric patients with attention-deficit/hyperactivity disorder with comorbid anxiety disorder［J］. J Am Acad Child Adolesc Psychiatry, 2007, 46(9): 1119-1127.