目的 系统评价艾司西酞普兰与西酞普兰治疗抑郁症的疗效与安全性。方法 计算机检索Pubmed、Medline、Embase（via OVID）、EBSCO、中国学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、维普中文期刊全文数据库（VIP）、万方数据库及相关临床试验注册网中有关艾司西酞普兰与西酞普兰治疗抑郁症的随机对照试验（RCTs），检索时限至2022年1月；2名研究者对纳入文献进行严格质量评价和数据、信息提取；采用RevMan 5.3软件对各效应指标进行Meta分析。结果 纳入8项RCTs，高质量文献占87.5%；共1 169例患者，其中试验组（艾司西酞普兰组）585例、对照组（西酞普兰组）584例。Meta分析结果显示：治疗6周末，两组治愈率［OR=1.70，95% CI（1.02，2.83），P＜0.05］、有效率［OR=1.36，95% CI（1.01，1.81），P＜0.05］比较，差异有统计学意义；两组发生恶心事件的差异有统计学意义［RR=0.69，95% CI（0.49，0.98），P＜0.05］，失眠、厌食（食欲不振）、头晕、转氨酶升高等发生率差异无统计学意义（P＞0.05）。结论 相比于西酞普兰，艾司西酞普兰治疗抑郁症的长期疗效更佳，但恶心风险发生率较高，建议临床使用时视患者耐受情况个体化选择。

Objective To systematically evaluate the efficacy and safety of escitalopram and citalopram in the treatment of depression. Methods Randomized controlled trials (RCTs) of escitalopram and citalopram in the treatment of depression were searched from PubMed, Medline, CNCID and other Chinese and English databases until January 2022. Two researchers carried out strict quality evaluation and data and information extraction on the included literature. RevMan 5.3 software was used for Metaanalysis of each effect index. Results Eight RCTs were included, accounting for 87.5% of high-quality literatures. A total of 1 169 patients were enrolled, including 585 in the experimental group (escitalopram group) and 584 in the control group (citalopram group). Meta-analysis showed that after 6 weeks of treatment, there were statistically significant differences in cure rate [OR = 1.70, 95%CI(1.02, 2.83), P<0.05] and effective rate [OR = 1.36, 95%CI(1.01, 1.81), P<0.05] between the two groups. In terms of safety, there was statistically significant difference in the incidence of nausea between the two groups [RR = 0.69, 95%CI(0.49, 0.98), P<0.05], while there was no statistically significant difference in the incidence of insomnia, anorexia (loss of appetite), dizziness and elevated aminotransferase (P>0.05). Conclusion Compared with citalopram, escitalopram has a better long-term efficacy in the treatment of depression, but has a higher risk of nausea. It is recommended that the clinical use of escitalopram be individualized according to patient tolerance.

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国家自然科学基金资助项目(82004073);四川省科技厅科技计划苗子工程重点项目(2022JDRC0146);四川省医学会(恒瑞)科研基金专项科研课题(2021HR26)