{"id":1721,"date":"2019-09-02T10:17:31","date_gmt":"2019-09-02T01:17:31","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=1721"},"modified":"2019-09-02T10:22:26","modified_gmt":"2019-09-02T01:22:26","slug":"%e6%88%90%e4%ba%ba%e3%81%ae%e5%a4%a7%e3%81%86%e3%81%a4%e7%97%85%e6%80%a7%e9%9a%9c%e5%ae%b3%e3%81%ab%e3%81%8a%e3%81%91%e3%82%8b21%e3%81%ae%e6%8a%97%e3%81%86%e3%81%a4%e8%96%ac%e3%81%ae%e5%8a%b9%e6%9e%9c","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=1721","title":{"rendered":"\u6210\u4eba\u306e\u5927\u3046\u3064\u75c5\u6027\u969c\u5bb3\u306b\u304a\u3051\u308b21\u306e\u6297\u3046\u3064\u85ac\u306e\u52b9\u679c\u3068\u8a8d\u5bb9\u6027\u306e\u6bd4\u8f03"},"content":{"rendered":"

\uff0d\u6587\u732e\u540d\uff0d
\nComparative efficacy and acceptability of 21 antidepressant\u3000drugs for the acute treatment of adults with major
\ndepressive\u3000disorder: a systematic review and network meta-analysis.Lancet 2018; 391: 1357\u201366<\/p>\n

\uff0d\u8981\u7d04\uff0d
\n\u80cc\u666f:
\n\u5927\u3046\u3064\u75c5\u6027\u969c\u5bb3\u306f\u4e16\u754c\u3067\u3082\u4e00\u822c\u7684\u3067\u96e3\u3057\u304f\u8cbb\u7528\u3092\u8981\u3059\u308b\u75be\u60a3\u3067\u3059\u3002\u85ac\u7269\u6cbb\u7642\u3068\u975e\u85ac\u7269\u6cbb\u7642\u304c\u3042\u308b\u304c\u8cc7\u6e90\u4e0d\u8db3\u304c\u80cc\u666f\u306b\u3042\u308a\u85ac\u7269\u6cbb\u7642\u304c\u591a\u304f\u7528\u3044\u3089\u308c\u3066\u3044\u308b\u73fe\u72b6\u304c\u3042\u308a\u307e\u3059\u3002
\n\u3053\u308c\u3089\u306e\u85ac\u5264\u306b\u3064\u3044\u3066\u9069\u5207\u306a\u6839\u62e0\u3092\u63d0\u793a\u3059\u308b\u5fc5\u8981\u304c\u3042\u308a\u3001\u4eca\u56de\u5927\u3046\u3064\u75c5\u6027\u969c\u5bb3\u306e\u6025\u6027\u671f\u6cbb\u7642\u306b\u304a\u3051\u308b\u6297\u3046\u3064\u85ac\u3092\u6bd4\u8f03\u3057\u30e9\u30f3\u30af\u3064\u3051\u3059\u308b\u305f\u3081\u306b\u6211\u3005\u306e\u4ee5\u524d\u306e\u7814\u7a76(12\u306e\u6297\u3046\u3064\u85ac\u306e\u6bd4\u8f03\u306e\u7814\u7a76)\u3092\u3055\u3089\u306bup date\u3057\u305f\u3002
\n\u65b9\u6cd5:\u30b7\u30b9\u30c6\u30de\u30c6\u30a3\u30c3\u30af\u30ec\u30d3\u30e5\u30fc\u3068\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u30e1\u30bf\u30a2\u30ca\u30ea\u30b7\u30b9\u3092\u7528\u3044\u305f\u3002\u30c7\u30fc\u30bf\u306fCochrane Central Register of\u3000Controlled Trials, CINAHL, Embase, LILACS database, MEDLINE, MEDLINE In-Process, PsycINFO\u3092\u7528\u3044\u3001\u691c\u7d22\u306f\u898f\u5236\u5f53\u5c40\u306e\u30a6\u30a7\u30d6\u30b5\u30a4\u30c8\u3001\u304a\u3088\u3073\u56fd\u969b\u767b\u9332\u7c3f\u3092\u691c\u7d22\u3057\u305f\u30022016\u5e741\u67088\u65e5\u307e\u3067\u306b\u516c\u958b\u3001\u975e\u516c\u958b\u3055\u308c\u3066\u3044\u308b\u4e8c\u91cd\u76f2\u691c\u5316\u7121\u4f5c\u70ba\u6bd4\u8f03\u8a66\u9a13\u3092\u7528\u3044\u307e\u3057\u305f\u3002
\n\u5bfe\u8c61\u306f\u6a19\u6e96\u7684\u306a\u57fa\u6e96(DSM-\u2162\uff5e\u2164,ICD-10)\u306b\u5f93\u3063\u3066\u8a3a\u65ad\u3055\u308c\u305f\u5927\u3046\u3064\u75c5\u6027\u969c\u5bb3\u3092\u6709\u3059\u308b\u6210\u4eba\uff0818\u6b73\u4ee5\u4e0a\u306e\u7537\u5973\uff09\u3067\u3042\u308a\u3001\u6025\u6027\u6cbb\u7642\u306b\u7528\u3044\u3089\u308c\u305f21\u306e\u6297\u3046\u3064\u85ac\u306e\u30d7\u30e9\u30bb\u30dc\u5bfe\u7167\u8a66\u9a13\u304a\u3088\u3073\u85ac\u5264\u540c\u58eb\u306e\u76f4\u63a5\u6bd4\u8f03\u8a66\u9a13\u3092\u542b\u3081\u305f\u3002
\n\u30d7\u30e9\u30a4\u30de\u30ea\u30a2\u30a6\u30c8\u30ab\u30e0\u306f\u6291\u3046\u3064\u6539\u5584\u306e\u6709\u52b9\u6027(\u6a19\u6e96\u7684\u5c3a\u5ea6\u3092\u7528\u3044\u306650\uff05\u4ee5\u4e0a\u306e\u6539\u5584)\u3068\u8a31\u5bb9\u6027(\u9014\u4e2d\u3067\u6cbb\u7642\u3092\u8131\u843d\u3057\u305f\u60a3\u8005\u306e\u5272\u5408)\u3067\u3042\u3063\u305f\u3002
\n\u30bb\u30ab\u30f3\u30c0\u30ea\u30fc\u30a2\u30a6\u30c8\u30ab\u30e0\u306f\u3001\u3046\u3064\u75c5\u30b9\u30b3\u30a2\u306e\u30a8\u30f3\u30c9\u30dd\u30a4\u30f3\u30c8\u3001\u5bdb\u89e3\u7387\u3001\u304a\u3088\u3073\u6709\u5bb3\u4e8b\u8c61\u306e\u305f\u3081\u306b\u65e9\u671f\u306b\u8131\u843d\u3057\u305f\u60a3\u8005\u306e\u5272\u5408\u3067\u3057\u305f\u3002
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\n\u9664\u5916\u57fa\u6e96\u3068\u3057\u3066\u306f\u6e96\u7121\u4f5c\u70ba\u5316\u8a66\u9a13\u304a\u3088\u3073\u4e0d\u5b8c\u5168\u306a\u8a66\u9a13\u3001\u307e\u305f\u306f\u5bfe\u8c61\u304c\u53cc\u6975\u6027\u969c\u5bb3\u3001\u7cbe\u795e\u75c5\u6027\u3046\u3064\u75c5(\u3046\u3064\u75c5\u306b\u5e7b\u899a\u5984\u60f3\u3092\u5408\u4f75\u3059\u308b\u75be\u60a3)\u3001\u6cbb\u7642\u62b5\u6297\u6027\u3046\u3064\u75c5\u3001\u91cd\u7be4\u306a\u533b\u5b66\u7684\u75be\u60a3(\u764c\u3001\u795e\u7d4c\u96e3\u75c5)\u3092\u4f75\u5b58\u3059\u308b\u3046\u3064\u75c5\u3068\u3057\u3001\u5168\u4f53\u306e\u7d0420\uff05\u4ee5\u4e0a\u304c\u9664\u5916\u3055\u308c\u305f\u3002
\n\u7814\u7a76\u306e\u30d0\u30a4\u30a2\u30b9\u30ea\u30b9\u30af\u306e\u8a55\u4fa1\u306f\u30b3\u30af\u30e9\u30f3\u30cf\u30f3\u30c9\u30d6\u30c3\u30af\u306b\u5f93\u3063\u3066\u884c\u3044\u3001\u3055\u3089\u306b\u30d7\u30e9\u30a4\u30de\u30ea\u30a2\u30a6\u30c8\u30ab\u30e0\u306e\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u63a8\u5b9a\u306b\u5bc4\u4e0e\u3059\u308b\u30a8\u30d3\u30c7\u30f3\u30b9\u306e\u8a55\u4fa1\u306b\u3064\u3044\u3066\u306fGRADE\u306e\u30d5\u30ec\u30fc\u30e0\u30ef\u30fc\u30af(moderate, low, very low)\u3092\u7528\u3044\u3066\u884c\u3063\u305f\u3002<\/p>\n

\u7d50\u679c:
\n1979\u5e74\uff5e2016\u5e74\u307e\u3067\u306728552\u4ef6\u306e\u5f15\u7528\u304c\u691c\u7d22\u306b\u3088\u3063\u3066\u7279\u5b9a\u3055\u308c\u3001680\u4ef6\u306e\u8ad6\u6587\u304c\u5168\u6587\u691c\u7d22\u3055\u308c\u305f\u3002\u3053\u306e\u4e2d\u304b\u3089116477\u4eba\u306e\u53c2\u52a0\u8005\u3092\u542b\u3080522\u306e\u4e8c\u91cd\u76f2\u898b\u5316\u6bd4\u8f03\u8a66\u9a13\u304c\u7528\u3044\u3089\u308c\u305f(figure1)\u3002
\nFigure2\u306f\u3001\u6709\u52b9\u6027\u3068\u8a31\u5bb9\u6027\u306b\u95a2\u3059\u308b\u9069\u683c\u306a\u6bd4\u8f03\u306e\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u3092\u793a\u3057\u3066\u3044\u307e\u3059(\u203b\u25cb\u306e\u5927\u304d\u3055\u304c\u7fa4\u6570\u3001\u7dda\u304c\u76f4\u63a5\u6bd4\u8f03\u3001\u7dda\u306e\u592a\u3055\u304c\u8a66\u9a13\u6570\u306e\u591a\u3055)\u3002
\n\u30df\u30eb\u30ca\u30b7\u30d7\u30e9\u30f3(SNRI\u3001\u30c8\u30ec\u30c9\u30df\u30f3)\u3092\u9664\u304f\u3059\u3079\u3066\u306e\u6297\u3046\u3064\u85ac\u306f\u3001\u5c11\u306a\u304f\u3068\u30821\u3064\u306e\u30d7\u30e9\u30bb\u30dc\u5bfe\u7167\u8a66\u9a13\u3092\u53d7\u3051\u307e\u3057\u305f\u3002
\n\u30ec\u30dc\u30df\u30eb\u30ca\u30b7\u30d7\u30e9\u30f3(\u65e5\u672c\u672a\u63a1\u7528)\u306e\u307f\u304c\u3001\u3044\u305a\u308c\u306e\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u306b\u304a\u3044\u3066\u3082\u5c11\u306a\u304f\u3068\u3082\u5225\u306e\u85ac\u7269\u3068\u76f4\u63a5\u6bd4\u8f03\u3055\u308c\u3066\u3044\u306a\u304b\u3063\u305f\u3002
\nFigure3(\u30d7\u30e9\u30a4\u30de\u30ea\u30a2\u30a6\u30c8\u30ab\u30e0)\u306f\u3059\u3079\u3066\u306e\u8a66\u9a13\u306e\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u30e1\u30bf\u30a2\u30ca\u30ea\u30b7\u30b9\u306e\u6709\u52b9\u6027\u3068\u8a8d\u5bb9\u6027\u306e\u30d5\u30a9\u30ec\u30b9\u30c8\u30d7\u30ed\u30c3\u30c8\u3092\u6297\u3046\u3064\u85ac\u3068\u30d7\u30e9\u30bb\u30dc\u3067\u6bd4\u8f03\u3057\u3066\u304a\u308a\u3001
\n\u6709\u52b9\u6027\u306b\u95a2\u3057\u3066\u306f\u3059\u3079\u3066\u6297\u3046\u3064\u85ac\u306f\u30d7\u30e9\u30bb\u30dc\u3088\u308a\u3082\u6709\u52b9\u3067\u3042\u308a\u3001\u6700\u3082\u52b9\u679c\u304c\u3042\u3063\u305f\u306e\u304c\u30a2\u30df\u30c8\u30ea\u30d7\u30c1\u30ea\u30f3(3\u74b0\u7cfb\u3001\u30c8\u30ea\u30d7\u30bf\u30ce\u30fc\u30eb)2.13\uff0895\uff05\u4fe1\u983c\u533a\u9593[CrI] 1\u30fb89\u301c2\u30fb41\uff09\u3067\u3001\u6b21\u304c\u30df\u30eb\u30bf\u30b6\u30d4\u30f3(NaSSa,\u30ea\u30d5\u30ec\u30c3\u30af\u30b9\u3001\u30ec\u30e1\u30ed\u30f3)\u3001\u6b21\u304c\u30c7\u30e5\u30ed\u30ad\u30bb\u30c1\u30f3(SNRI,\u30b5\u30a4\u30f3\u30d0\u30eb\u30bf)\u3067\u3042\u3063\u305f\u3002
\n\u6700\u3082\u52b9\u679c\u304c\u4f4e\u304b\u3063\u305f\u306e\u306f\u30ec\u30dc\u30ad\u30bb\u30c1\u30f3(SSRI,\u30ec\u30af\u30b5\u30d7\u30ed)1\u30fb37\uff081\u30fb16\u301c1\u30fb63\uff09\u3002
\n\u8a8d\u5bb9\u6027\u306b\u95a2\u3057\u3066\u306f\u3001\u30a2\u30b4\u30e1\u30e9\u30c1\u30f3(\u30d0\u30eb\u30c8\u30ad\u30b5\u30f3(NDDI(\u30ce\u30eb\u30a2\u30c9\u30ec\u30ca\u30ea\u30f3\u30fb\u30c9\u30d1\u30df\u30f3\u8131\u6291\u5236\u85ac(\u65e5\u672c\u63a1\u7528\u306a\u3057)) (OR 0\u30fb84\u300195\uff05CrI 0\u30fb72\u301c0\u30fb97)\u304a\u3088\u3073\u30d5\u30eb\u30aa\u30ad\u30bb\u30c1\u30f3(SSRI,\u65e5\u672c\u672a\u627f\u8a8d)(0\u30fb88\u30010\u30fb80\u301c96)\u304c\u95a2\u9023\u3057\u3066\u3044\u305f\u30d7\u30e9\u30bb\u30dc\u3088\u308a\u3082\u30c9\u30ed\u30c3\u30d7\u30a2\u30a6\u30c8\u304c\u5c11\u306a\u304f\u3001\u5bfe\u7167\u7684\u306b\u30af\u30ed\u30df\u30d7\u30e9\u30df\u30f3(3\u74b0\u7cfb,\u30a2\u30ca\u30d5\u30e9\u30cb\u30fc\u30eb)\u306f\u30d7\u30e9\u30bb\u30dc\u3088\u308a\u3082\u60aa\u304b\u3063\u305f(1\u30fb30\u30011\u30fb01\u301c1\u30fb68)\u3002\u6bd4\u8f03\u306e\u30eb\u30fc\u30d7\u306f8\uff05\u304c\u4e00\u81f4\u3057\u3066\u3044\u306a\u304b\u3063\u305f\u3002
\n\u7570\u8cea\u6027\u306f\u6709\u52b9\u6027\u30670.044\uff0895\uff05CrI 0.028\u20130.063\uff09\u3001\u5bdb\u5bb9\u6027\u306b\u3064\u3044\u3066\u306f0.040\uff080.023\u20130.062\uff09\u3068\u63a8\u5b9a\u3055\u308c\u4e2d\u7a0b\u5ea6\u304b\u3089\u4f4e\u3044\u3053\u3068\u304c\u793a\u5506\u3055\u308c\u307e\u3057\u305f\u3002
\n\u30d0\u30a4\u30a2\u30b9\u30ea\u30b9\u30af\u306f522\u4ef6\u306e\u8a66\u9a13\u306e\u3046\u306146\u4ef6\uff089\uff05\uff09\u306f\u30ea\u30b9\u30af\u304c\u9ad8\u304f\u3001380\u4ef6\uff0873\uff05\uff09\u304c\u4e2d\u7a0b\u5ea6\u300196\u4ef6\uff0818\uff05\uff09\u304c\u4f4e\u3068\u8a55\u4fa1\u3055\u308c\u307e\u3057\u305f\u3002
\n\u305d\u3057\u3066\u8a3c\u62e0\u306e\u78ba\u5b9f\u6027\u306f\u4e2d\u7a0b\u5ea6\u304b\u3089\u975e\u5e38\u306b\u4f4e\u304b\u3063\u305f\u3002
\nFigure 4\u3067\u306f\u30d7\u30e9\u30a4\u30de\u30ea\u30a2\u30a6\u30c8\u30ab\u30e0(\u6709\u52b9\u6027\u3068\u8a8d\u5bb9\u6027)\u306b\u5bfe\u3059\u308b\u6297\u3046\u3064\u85ac\u540c\u58eb\u306e\u76f4\u63a5\u6bd4\u8f03(\u5bfe\u9762\u7814\u7a76)\u3092\u793a\u3057\u3066\u3044\u307e\u3059\u3002
\n\u3053\u308c\u306b\u3088\u308b\u3068\u30af\u30ed\u30df\u30d7\u30e9\u30df\u30f3\u3001\u30c7\u30e5\u30ed\u30ad\u30bb\u30c1\u30f3\u3001\u30d5\u30eb\u30dc\u30ad\u30b5\u30df\u30f3\u3001\u30ec\u30dc\u30ad\u30bb\u30c1\u30f3\u3001\u30c8\u30e9\u30be\u30c9\u30f3\u3001\u304a\u3088\u3073\u30d9\u30f3\u30e9\u30d5\u30a1\u30ad\u30b7\u30f3\u304c\u6700\u3082\u9ad8\u3044\u30c9\u30ed\u30c3\u30d7\u30a2\u30a6\u30c8\u7387\u306b\u95a2\u9023\u3059\u308b\u6297\u3046\u3064\u3067\u3057\u305f\u3002
\n\u6709\u52b9\u6027\u306b\u3064\u3044\u3066\u306f\u30a2\u30df\u30c8\u30ea\u30d7\u30c1\u30f3\u3001\u30df\u30eb\u30b6\u30bf\u30d4\u30f3\u3001\u30c7\u30e5\u30ed\u30ad\u30bb\u30c1\u30f3\u306e\u9806\u3067\u3057\u305f\u3002\u3059\u3079\u3066\u306e\u6297\u3046\u3064\u85ac\u9593\u306eOR\u306e\u5dee\u306f\u6709\u52b9\u6027\u30671\u30fb15\uff5e1\u30fb55\u3001\u8a31\u5bb9\u6027\u30670\u30fb64\uff5e0\u30fb83\u306e\u7bc4\u56f2\u3067\u3042\u3063\u305f\u3002
\nFigure4\u306bGRADE\u306e\u5224\u65ad\u3092\u7d44\u307f\u8fbc\u3080\u3068\u30a2\u30b4\u30e1\u30e9\u30c1\u30f3\u3001\u30a8\u30b9\u30b7\u30bf\u30ed\u30d7\u30e9\u30e0\u3001\u30b7\u30bf\u30ed\u30d7\u30e9\u30e0\u3001\u304a\u3088\u3073\u30df\u30eb\u30bf\u30b6\u30d4\u30f3\u306e\u6bd4\u8f03\u306e\u5927\u90e8\u5206\u3067\u306fmoderate\u3067\u3042\u308a\u3001
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