肠-大脑神经调节剂在刺激性肠综合征中的有效性:更新的系统性审查和元分析
Mais Khasawneh1, Marjan Mokhtare2, Paul Moayyedi3
1Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
The lancet. Gastroenterology & hepatology
|April 21, 2025
概括
肠-大脑神经调节剂,特别是三环抗抑郁药 (TCA),有效地减少刺激性肠综合征 (IBS) 症状和腹痛. 虽然TCA显示了最强有力的证据,但选择性血清素再吸收抑制剂 (SSRI) 也可能有利于IBS患者的疼痛管理.
科学领域:
- 胃肠病学 胃肠病学
- 药理学 药理学是指药理学的学科.
- 临床试验 临床试验
背景情况:
- 刺激性肠综合征 (IBS) 的管理仍然是一个挑战,肠脑神经调节剂显示出潜在的有效性.
- 从随机对照试验 (RCT) 中缺乏针对特定药物类别及其在IBS中的疼痛修饰作用的证据综合.
研究的目的:
- 更新针对IBS的肠-大脑神经调节器的RCT的系统审查和元分析.
- 评估这些药物在减少全球IBS症状和腹部疼痛方面的有效性.
- 评估IBS治疗中不同药物类别的疼痛修饰性质.
主要方法:
- 在MEDLINE,Embase和Cochrane中央注册表中进行全面的文献搜索,截至2025年1月1日.
- 在成年IBS患者中至少4周内将肠-大脑神经调节剂与安慰剂进行比较的RCT的纳入.
- 使用随机效应模型汇集二分型症状数据来计算相对风险 (RR) 仍然有症状.
主要成果:
- 包括28个RCT (2475名患者);自上次审查以来,确定了10个新的RCT (1348名患者).
- 肠脑神经调节剂显示,全球IBS症状的RR降低,没有改善 (0.77;95% CI 0.69-0.87).
- 三环抗抑郁药 (TCA) 显示了减少全球IBS症状 (RR 0.70) 和腹痛 (RR 0.69) 的最强有力的证据.
- 选择性血清素再吸收抑制剂 (SSRI) 和血清素和上腺素再吸收抑制剂 (SNRIs) 也显示出对腹痛的潜在益处.
- 不良事件没有显著增加,但由于不良事件而导致的戒断率更高.
结论:
- 肠脑神经调节剂,特别是TCA,对全球IBS症状和腹痛有效.
- 这些发现支持目前的指导方针,建议TCA治疗持续的IBS症状和疼痛.
- 对于IBS相关的腹痛,SSRI可能会提供适度的益处,这需要进一步调查.
- 对于SNRIs,阿扎皮龙和四环抗抑郁药在IBS治疗中需要更多的数据.
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