發(fā)布時(shí)間：2018-04-15 00:14

  本文選題：阿爾茨海默病 + 膽堿酯酶抑制劑��； 參考：《中國(guó)全科醫(yī)學(xué)》2017年14期

【摘要】：目的探討4種膽堿酯酶抑制劑(多奈哌齊、加蘭他敏、石杉?jí)A甲、卡巴拉汀)治療輕中度阿爾茨海默病(AD)患者的療效。方法計(jì)算機(jī)檢索Pub Med、EMBase、Cochrane Library、Web of Science、中國(guó)知網(wǎng)、萬(wàn)方數(shù)據(jù)知識(shí)服務(wù)平臺(tái)、維普網(wǎng)、中國(guó)生物醫(yī)學(xué)網(wǎng),檢索時(shí)限為1994年1月—2016年3月,納入關(guān)于膽堿酯酶抑制劑治療輕中度AD患者的隨機(jī)雙盲安慰劑對(duì)照試驗(yàn)。對(duì)納入文獻(xiàn)進(jìn)行數(shù)據(jù)提取和質(zhì)量評(píng)價(jià),提取包括第一作者、發(fā)表時(shí)間、藥物、日給藥劑量、性別、年齡、觀察時(shí)間、基線簡(jiǎn)易精神狀態(tài)評(píng)價(jià)量表(MMSE)評(píng)分、結(jié)局指標(biāo)等資料。采用RevMan 5.3軟件分析多奈哌齊、加蘭他敏、石杉?jí)A甲、卡巴拉汀改善輕中度AD患者阿爾茨海默病評(píng)定量表-認(rèn)知項(xiàng)目(ADAS-cog)和MMSE評(píng)分的效果。結(jié)果共納入30篇文獻(xiàn),其中多奈哌齊15篇,加蘭他敏7篇,石杉?jí)A甲4篇,卡巴拉汀4篇。Meta分析結(jié)果顯示,多奈哌齊5 mg組、多奈哌齊10 mg組、加蘭他敏24 mg組、加蘭他敏32 mg組、卡巴拉汀12 mg組ADAS-cog評(píng)分均低于安慰劑組[加權(quán)均數(shù)差(WMD)=-2.13,95%CI(-2.69,-1.57),P0.001;WMD=-2.03,95%CI(-2.80,-1.25),P0.001;WMD=-3.05,95%CI(-3.54,-2.55),P0.001;WMD=-2.64,95%CI(-3.55,-1.73),P0.001;WMD=-2.17,95%CI(-3.30,-1.04),P0.001]。石杉?jí)A甲400μg組和安慰劑組ADAS-cog評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[WMD=-2.95,95%CI(-8.19,2.29),P=0.270]。多奈哌齊5 mg組、多奈哌齊10 mg組、石杉?jí)A甲400μg組、卡巴他汀12 mg組MMSE評(píng)分均高于安慰劑組[WMD=1.07,95%CI(0.55,1.59),P0.001;WMD=1.20,95%CI(0.91,1.50),P0.001;WMD=2.47,95%CI(1.15,3.78),P0.001;WMD=1.23,95%CI(0.35,2.11),P=0.006]。Begg秩相關(guān)檢驗(yàn)、Egger線性回歸分析,ADAS-cog納入文獻(xiàn)P值分別為0.511、0.755;MMSE納入文獻(xiàn)P值分別為0.441、0.212,未觀察到發(fā)表偏倚。結(jié)論除石杉?jí)A甲外,其他膽堿酯酶抑制劑治療輕中度AD患者認(rèn)知功能減退效果顯著。石杉?jí)A甲治療效果仍有待納入高質(zhì)量文獻(xiàn)進(jìn)一步論證。
[Abstract]:Objective to investigate the efficacy of four cholinesterase inhibitors (Donepezil, galantamine, Huperzine A, carbaradine) in the treatment of mild and moderate Alzheimer's disease (AD).Methods A computer search was conducted for Pub Medsite EMBaseCrane Library of Science, China knowledge Network, Wanfang data knowledge Service platform, Weipu Web, and China Biomedical Network. The search time was from January 1994 to March 2016.A randomized, double-blind placebo controlled trial of cholinesterase inhibitors for mild to moderate AD.Data extraction and quality evaluation were carried out in the literature. The extraction included data of the first author, time of publication, drug, daily dosage, sex, age, observation time, baseline MMSE score, outcome index and so on.The effects of Donepezil, Galantamine, Huperzine A and Cabalatin on Alzheimer's disease rating scale (ADAS-cog) and MMSE score in patients with mild and moderate AD were analyzed by RevMan 5.3 software.Results A total of 30 articles were included, including 15 articles of Donepezil, 7 articles of galantamine, 4 papers of Huperzine A, 4 articles of carbaradine. The results of Meta analysis showed that the group of 5 mg of Donepezil, 10 mg group of Donepezil, 24 mg group of Galantamine, and 5 mg of Donepezil were involved in the study.There was no significant difference in the ADAS-cog score between the 400 渭 g Huperzine A group and the placebo group [WMD-2.95 ~ 95 CI ~ (-8.192.29) P 0.270].Donepezil 5 mg group, Donepezil 10 mg group, Huperzine A 400 渭 g group.Conclusion except Huperzine A, other cholinesterase inhibitors are effective in the treatment of cognitive impairment in mild and moderate AD patients.The therapeutic effect of Huperzine A still needs to be further demonstrated in high-quality literature.
【作者單位】： 首都醫(yī)科大學(xué)公共衛(wèi)生學(xué)院;北京市海淀區(qū)北下關(guān)社區(qū)衛(wèi)生服務(wù)中心;
【分類號(hào)】：R749.16

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