摘要
目的系统评价奥氮平对比利培酮治疗阿尔茨海默病精神行为症状的有效性和安全性,旨在为临床合理用药提供循证参考。方法计算机检索PubMed、Embase、Cochrane library、中国知网、万方数据库、维普数据库和中国生物医学文献数据库,收集各数据库自建库至2020年8月发表的奥氮平(试验组)对比利培酮(对照组)治疗阿尔茨海默病精神行为症状的随机对照试验(RCT)。筛选文献,提取数据,使用Cochrane系统评价员手册偏倚风险评估工具进行文献质量评价,采用Rev Man 5.3软件进行meta分析。结果共纳入13项RCT,共计1448例患者。meta分析结果显示,试验组总有效率[RR=1.14,95%CI(1.06,1.23),P=0.0008]显著高于对照组,治疗2周后[WMD=-2.67,95%CI(-3.79,-1.55),P<0.00001]、4周后[WMD=-2.83,95%CI(-4.02,-1.65),P<0.00001]的试验组阿尔茨海默病病理行为评定量表评分均显著低于对照组;两组治疗8周后的阿尔茨海默病病理行为评定量表评分[WMD=-1.40,95%CI(-4.34,1.54),P=0.35]及简易智力状态检查量表评分[WMD=1.01,95%CI(-1.73,3.76),P=0.47]比较,差异无统计学意义。试验组锥体外系反应发生率[RR=0.52,95%CI(0.34,0.80),P=0.003]、失眠发生率[RR=0.49,95%CI(0.32,0.76),P=0.002]均显著低于对照组,两组头痛、乏力、视物模糊、激惹、肝功能、体质量增加、嗜睡发生率比较,差异均无统计学意义(P>0.05)。结论奥氮平治疗阿尔茨海默病精神行为症状的效果优于利培酮,锥体外系反应和失眠发生率低于利培酮。
Objective To systematically evaluate the efficacy and safety of Olanzapine compared with Risperidone in the treatment of mental and behavioral symptoms of Alzheimer’s disease, in order to provide evidence-based reference for rational clinical drug use. Methods PubMed, Embase, Cochrane Library, CNKI, Wanfang Database, VIP Database and Chinese Biomedical Literature Database were searched by computer. Randomized controlled trials(RCT) of Olanzapine(experimental group) compared with Risperidone(control group) in the treatment of mental and behavioral symptoms of Alzheimer’s disease from inception to published in August 2020 of each database were collected. Literature was screened, data were extracted,literature quality was evaluated using the Cochrane handbook for systematic reviews of bias risk assessment tool, and meta-analysis was performed using RevMan 5.3 software. Results A total of 13 studies were included, with a total of 1448 patients. Meta-analysis showed that the total effective rate of experimental group(RR = 1.14, 95% CI[1.06, 1.23], P = 0.0008) was significantly higher than that of control group. After two weeks of treatment(WMD =-2.67,95%CI [-3.79,-1.55], P < 0.000 01) and four weeks later(WMD =-2.83, 95%CI [-4.02,-1.65], P < 0.000 01) the scores of rating scale of the behavioral pathology in Alzheimer’s disease in experimental group were significantly lower than those in control group. After eight weeks of treatment, there were no significant differences between the two groups in the scores of rating scale of the behavioral pathology in Alzheimer’s disease(WMD =-1.40, 95%CI [-4.34, 1.54], P =0.35) and the scores of mini mental state examination(WMD = 1.01, 95%CI [-1.73, 3.76], P = 0.47). The incidence of extrapyramidal reaction in experimental group(RR = 0.52, 95%CI [0.34, 0.80], P = 0.003) and the incidence of insomnia in experimental group(RR = 0.49, 95%CI [0.32, 0.76], P = 0.002) were significantly lower than those in control group. There were no significant differences in the incidence of headache, fatigue, blurred vision, irritation, liver function, increased body mass and lethargy between the two groups(P > 0.05). Conclusion Olanzapine is more effective than Risperidone in the treatment of mental and behavioral symptoms of Alzheimer’s disease, and the incidence of extrapyramidal reaction and insomnia is lower than Risperidone.
作者
韩富华
欧阳嘉慧
陶庄
詹敏
乔丹丹
陈文洁
孙林娟
缴秀珍
HAN Fuhua;OUYANG Jiahui;TAO Zhuang;ZHAN Min;QIAO Dandan;CHEN Wenjie;SUN Linjuan;JIAO Xiuzhen(Graduate School,Beijing University of Chinese Medicine,Beijing100029,China;Department of Encephalopathy,Xiyuan Hospital,Chinese Academy of Chinese Medical Sciences,Beijing100091,China;Basic Research Office,Institute of Basic Theory of Traditional Chinese Medicine,Chinese Academy of Chinese Medical Sciences,Beijing100700,China;Department of Encephalopathy,Botou Hospital of Traditional Chinese Medicine,Hebei Province,Cangzhou061000,China)
出处
《中国医药导报》
CAS
2021年第35期80-87,共8页
China Medical Herald
基金
国家自然科学基金面上项目(81873168)
国家自然科学基金青年科学基金项目(81503450)。
