胆碱酯酶抑制剂改善轻中度阿尔茨海默病患者认知疗效的Meta分析

发布时间：2018-04-15 00:14

本文选题：阿尔茨海默病 + 胆碱酯酶抑制剂　；参考：《中国全科医学》2017年14期

【摘要】：目的探讨4种胆碱酯酶抑制剂(多奈哌齐、加兰他敏、石杉碱甲、卡巴拉汀)治疗轻中度阿尔茨海默病(AD)患者的疗效。方法计算机检索Pub Med、EMBase、Cochrane Library、Web of Science、中国知网、万方数据知识服务平台、维普网、中国生物医学网,检索时限为1994年1月—2016年3月,纳入关于胆碱酯酶抑制剂治疗轻中度AD患者的随机双盲安慰剂对照试验。对纳入文献进行数据提取和质量评价,提取包括第一作者、发表时间、药物、日给药剂量、性别、年龄、观察时间、基线简易精神状态评价量表(MMSE)评分、结局指标等资料。采用RevMan 5.3软件分析多奈哌齐、加兰他敏、石杉碱甲、卡巴拉汀改善轻中度AD患者阿尔茨海默病评定量表-认知项目(ADAS-cog)和MMSE评分的效果。结果共纳入30篇文献,其中多奈哌齐15篇,加兰他敏7篇,石杉碱甲4篇,卡巴拉汀4篇。Meta分析结果显示,多奈哌齐5 mg组、多奈哌齐10 mg组、加兰他敏24 mg组、加兰他敏32 mg组、卡巴拉汀12 mg组ADAS-cog评分均低于安慰剂组[加权均数差(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]。石杉碱甲400μg组和安慰剂组ADAS-cog评分比较,差异无统计学意义[WMD=-2.95,95%CI(-8.19,2.29),P=0.270]。多奈哌齐5 mg组、多奈哌齐10 mg组、石杉碱甲400μg组、卡巴他汀12 mg组MMSE评分均高于安慰剂组[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秩相关检验、Egger线性回归分析,ADAS-cog纳入文献P值分别为0.511、0.755;MMSE纳入文献P值分别为0.441、0.212,未观察到发表偏倚。结论除石杉碱甲外,其他胆碱酯酶抑制剂治疗轻中度AD患者认知功能减退效果显著。石杉碱甲治疗效果仍有待纳入高质量文献进一步论证。
[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.
【作者单位】：首都医科大学公共卫生学院;北京市海淀区北下关社区卫生服务中心;
【分类号】：R749.16

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