【摘要】：目的:應(yīng)用網(wǎng)絡(luò)Meta分析(Network Meta-analysis,NMA)方法全面而系統(tǒng)評(píng)價(jià)不同的抗癡呆藥物對(duì)于阿爾茲海默病患者認(rèn)知功能改善的作用,以期為阿爾茲海默病的臨床治療提供臨床參考。方法:計(jì)算機(jī)檢索pubmed數(shù)據(jù)庫(kù)、web of science數(shù)據(jù)庫(kù)、clinicaltrials、embase、cohranne圖書(shū)館、中國(guó)知網(wǎng)、cbm數(shù)據(jù)庫(kù)、萬(wàn)方數(shù)據(jù)庫(kù)等數(shù)據(jù)庫(kù)中有關(guān)于各類(lèi)抗癡呆藥物治療阿爾茲海默病的隨機(jī)對(duì)照試驗(yàn)(Randomized Controlled trials,RCTs),依據(jù)嚴(yán)格的納入及排除標(biāo)準(zhǔn),對(duì)初步檢索出的文獻(xiàn)進(jìn)行篩選,最終納入文獻(xiàn)為33篇,共計(jì)8039例患者。其中治療組共計(jì)患者4468例,安慰劑組共計(jì)納入患者3571例。主要評(píng)價(jià)指標(biāo)為簡(jiǎn)易智能評(píng)價(jià)量表(mini-mental state examination,MMSE)量表,將納入的33篇文獻(xiàn)按照MMSE量表分為輕度、中度、重度3個(gè)亞組,AD患者輕度認(rèn)知功能下降共納入文獻(xiàn)11篇,納入藥物12種(含安慰劑),共計(jì)納入患者3800例,其中治療組1830例,對(duì)照組1970例。AD患者中度認(rèn)知功能下降組共納入文獻(xiàn)17篇,納入藥物15種(含安慰劑)納入患者共計(jì)3194例,其中治療組2108例,對(duì)照組1086例。AD患者重度認(rèn)知功能障礙組共計(jì)納入文獻(xiàn)5篇,納入藥物3種(含安慰劑),納入患者共計(jì)1045例,其中治療組530例,對(duì)照組515例。根據(jù)納入研究文獻(xiàn)的異質(zhì)性大小,通過(guò)R軟件采用隨機(jī)效應(yīng)模型進(jìn)行網(wǎng)絡(luò)Meta分析。對(duì)于直接及間接比較結(jié)果進(jìn)行合并,并應(yīng)用R軟件中Gemtc數(shù)據(jù)包進(jìn)行異質(zhì)性及節(jié)點(diǎn)分析來(lái)檢驗(yàn)所納入文獻(xiàn)的異質(zhì)性,采用Gemtc數(shù)據(jù)包進(jìn)行治療效果的排序。結(jié)果與結(jié)論:效應(yīng)量采用MD值及其95%置信區(qū)間表示,若MD值0,則證明該藥物對(duì)于減緩阿爾茲海默病患者認(rèn)知功能下降成正相關(guān),在AD患者輕度認(rèn)知功能障礙亞組中,所納入的藥物中療效最為顯著的是多奈哌齊、加蘭他敏與石杉?jí)A甲。MD值分別為5.2、2.5與2.4。鋰、葉酸、維生素E、辛伐他汀與安慰劑相比,MD值分別為-0.62、-0.16、-0.0021與-1.6�？紤]這四種藥物對(duì)于改善阿爾茲海默病患者輕度認(rèn)知功能下降無(wú)明顯作用。在所納入的12種治療藥物中,多奈哌齊治療AD患者輕度認(rèn)知功能障礙療效最佳,其余藥物按療效大小排序?yàn)榧犹m他敏石杉?jí)A甲褪黑素美金剛雌激素阿托伐他汀維生素E葉酸安慰劑鋰辛伐他汀。在AD患者中度認(rèn)知功能障礙亞組中,療效最為顯著的是多奈哌齊、石杉?jí)A甲與卡巴拉汀。MD值分別為3.8、2.9與3.0。其中雌激素、SB-742457和Dimebon、辛伐他汀與安慰劑相比,MD值分別為-0.31、-0.39、-3.7、-0.035�？紤]這四種藥物對(duì)于改善阿爾茲海默病患者中度認(rèn)知功能下降無(wú)明顯作用。在所納入的15種治療藥物中,多奈哌齊治療AD患者中度認(rèn)知功能障礙療效最佳,按療效大小排序?yàn)槎嗄芜啐R石杉?jí)A甲卡巴拉汀加蘭他敏美金剛艾地苯醌N-乙酰半胱氨酸氟伐他汀阿托伐他汀阿立哌唑辛伐他汀安慰劑雌激素SB-742457Dimebon。在AD患者重度認(rèn)知功能障礙亞組中,多奈哌齊減緩AD患者重度認(rèn)知功能障礙的作用較美金剛突出。
[Abstract]:Objective: to evaluate the effects of different antidementia drugs on cognitive improvement of patients with Alzheimer's disease by network meta-analysis (NMA) method, and to provide clinical reference for the clinical treatment of Alzheimer's disease. Methods: the pubmed database pubmed of science was searched by computer, and the CBM database was obtained from the library of clinicaltrialsembasecohranne. There are random controlled trialsof RCTs (Randomized controlled trialsof RCTs) in Wanfang database and other databases. According to the strict criteria of inclusion and exclusion, the preliminary retrieved documents are screened, and 33 articles are included. A total of 8039 patients. There were 4468 patients in the treatment group and 3571 patients in the placebo group. The main evaluation index was the mini-mental state examination scale (MMSE). According to MMSE, 33 articles were divided into mild, moderate and severe subgroups with mild cognitive impairment. A total of 3800 patients were included in 12 kinds of drugs (including placebo), including 1830 patients in the treatment group, 1970 patients in the control group, 1970 patients with moderate cognitive impairment of AD patients, 17 papers were included in the study, and 3194 patients were included in 15 kinds of drugs (including placebo). There were 2108 cases in the treatment group and 1086 cases in the control group. The patients with severe cognitive dysfunction in AD group were included in 5 articles, 3 kinds of drugs (including placebo) and 1045 cases were included in the treatment group and the control group, among them, there were 515 cases in the treatment group and 515 cases in the control group. According to the heterogeneity of the literature, the random effect model was used to analyze the meta-analysis of network by R software. The results of direct and indirect comparison were merged, and the heterogeneity of Gemtc data packets in R software and node analysis were used to check the heterogeneity of the included literatures, and Gemtc data packets were used to sort the therapeutic effects. Results and conclusion: the effect was expressed by MD value and 95% confidence interval. If MD value is 0, it is proved that the drug has a positive correlation with the decrease of cognitive function in patients with Alzheimer's disease, in the subgroup of mild cognitive impairment in AD patients. The most effective drug was Donepezil. The values of Galantamine and Huperzine A. MD were 5. 2 and 2. 5 and 2. 4 respectively. The MD values of lithium, folic acid, vitamin E and simvastatin compared with placebo were -0.62U -0.16N -0.0021 and -1.621, respectively. Consideration of these four drugs had no significant effect on improving mild cognitive impairment in patients with Alzheimer's disease. Of the 12 drugs included, Donepezil was the best in the treatment of mild cognitive impairment in patients with AD. The other drugs were Galantamine Huperzine, melatonin, Atto estradiol, vitamin E, folic acid placebo, lithium simvastatin. In AD patients with moderate cognitive impairment subgroup, the most significant curative effect was Donepezil, the values of Huperzine A and carbatin 路MD were 3.82.9 and 3.0, respectively. Among them, estrogen SB-742457 and Dimebon.Simvastatin compared with placebo, the MD values of SB-742457, simvastatin and placebo were -0.31 and -0.39, respectively, and those of simvastatin and placebo were -0.31, -0.39 and 3.7 and 0.035, respectively. Consideration of these four drugs had no significant effect on improving moderate cognitive impairment in patients with Alzheimer's disease. Of the 15 drugs included, Donepezil was the best in the treatment of moderate cognitive impairment in patients with AD. According to the therapeutic effect, the order of efficacy was Donepiperzepine methylcarbaradine plus adenosemide, N-acetylcysteine, fluvastatin, Atto statin, aripiprazole, simvastatin, placebo, SB-742457 Dimebon. In the subgroup of severe cognitive dysfunction in AD patients, Donepezil was more effective in relieving severe cognitive dysfunction in AD patients than in MJ.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R749.16

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 姚佳紅,李輝;阿爾茲海默病危險(xiǎn)因素的病例對(duì)照研究[J];中國(guó)公共衛(wèi)生;2002年02期

2 劉坤梅,丁宛瓊;早發(fā)家族阿爾茲海默病1個(gè)家系報(bào)道[J];職業(yè)衛(wèi)生與病傷;2002年04期

3 李電東;第九屆國(guó)際阿爾茲海默病會(huì)議在美國(guó)費(fèi)城召開(kāi)[J];中國(guó)新藥雜志;2004年08期

4 孫磊;楊瑩;竇彩艷;;阿爾茲海默病治療的研究進(jìn)展[J];醫(yī)學(xué)信息(中旬刊);2010年07期

5 王艷平;翟靜波;朱芳;張?chǎng)?楊曉娟;曲成毅;;社區(qū)老年人阿爾茲海默病患病及影響因素分析[J];中國(guó)公共衛(wèi)生;2011年07期

6 翟月;;線(xiàn)粒體平衡在阿爾茲海默病中的作用[J];中國(guó)科技信息;2012年10期

7 張于;程偉;;中西醫(yī)治療阿爾茲海默病的研究現(xiàn)狀[J];中醫(yī)臨床研究;2012年13期

8 鄭亞楠;甘小榮;;我國(guó)阿爾茲海默病相關(guān)心理學(xué)研究綜述[J];中國(guó)實(shí)用醫(yī)藥;2013年08期

9 謝嵐;艾華;;運(yùn)動(dòng)對(duì)阿爾茲海默病影響的研究進(jìn)展[J];中國(guó)運(yùn)動(dòng)醫(yī)學(xué)雜志;2013年09期

10 左萍萍;β淀粉樣肽代謝與阿爾茲海默病[J];標(biāo)記免疫分析與臨床;2001年01期

相關(guān)會(huì)議論文 前6條

1 苗雅;何婷;鐘遠(yuǎn);;阿爾茲海默病與磷酸二酯酶4相關(guān)性的研究進(jìn)展(綜述)[A];第三屆江浙滬三地老年醫(yī)學(xué)高峰論壇暨2012年浙江省老年醫(yī)學(xué)學(xué)術(shù)年會(huì)論文集[C];2012年

2 曼淑梅;陳譽(yù)華;;阿爾茲海默病人外周血免疫細(xì)胞穿過(guò)血腦屏障能力分析[A];中國(guó)細(xì)胞生物學(xué)學(xué)會(huì)第八屆會(huì)員代表大會(huì)暨學(xué)術(shù)大會(huì)論文摘要集[C];2003年

3 孫一_，

本文編號(hào)：2129189