罗替戈汀透皮贴治疗帕金森病神经精神症状的Meta分析

Meta analysis of Rotigotine Transdermal Patches in the treatment of neuropsychiatric symptoms in the patients with Parkinson′s disease

目的系统评价罗替戈汀透皮贴对帕金森病(PD)神经精神症状的治疗效果。方法检索Pubmed、Clinic trails、Cochrane Library、Embase数据库,检索时间从建库到2017年9月1日,搜集罗替戈汀透皮贴治疗PD神经精神症状的RCT文献。由2名研究者严格按照纳入与排除标准独立筛选文献、提取资料并评价质量,由第3位研究者审核,使用Rev Man 5.3软件进行Meta分析。结果最终纳入8个随机对照试验,共计1675例PD患者。Meta分析结果显示,罗替戈汀透皮贴在NMSS的情绪/淡漠方面、BDI-Ⅱ、AS、NMSS的睡眠/疲劳方面、PDQ-8、PDQ-39的评分上优于对照组,差异有统计学意义[NMSS的情绪/淡漠方面:MD=-2.5,95%CI(-4.11,-0.89),P=0.002;BDI-Ⅱ:MD=-1.19,95%CI(-2.30,-0.08),P=0.04;AS:MD=-1.56,95%CI(-2.67,-0.45),P=0.006;NMSS的睡眠/疲劳方面:MD=-2.03,95%CI(-3.08,-0.98),P=0.001;PDQ-8:MD=-4.93,95%CI(-6.79,-3.07),P<0.00001;PDQ-39:MD=-3.52,95%CI(-5.25,-1.79),P<0.0001]。PDSS-2的研究间偏倚过大。SHAPS的结果差异无统计学意义[MD=-0.12,95%CI(-0.58,0.34),P=0.61]。结论罗替戈汀透皮贴与对照组相比可有效改善PD神经精神症状,提高患者生活质量,结论尚需进一步研究。

Objective To systematically evaluate the therapeutic effect of rotigotine transdermal patch in the treatment of neuropsychiatric symptoms of Parkinson＇s disease （PD）. Methods PubMed,Clinic trails,Cochrane Library,Embase database were searched.The search time was from database building to September 1,2017.RCT literature of rotigotine transdermal patch in the treatment of PD neuropsychiatric symptoms was collected.The inclusion and exclusion criteria were strictly followed by two investigators for independent screening of documents,extracting information and evaluating the quality, and the literature was reviewed by the third investigator.Meta-analysis was performed using RevMan 5.3 software.Re- suits Finally,8 randomized controlled trials were included,with a total of 1675 PD patients.Meta analysis showed that,in the aspects of mood/indifference of NMSS,sleep/fatigue of BDI- 11 ,AS and NMSS,the scores of PDQ-8 and PDQ-39, rotigotine transdermal patch was superior to the control group,and the difference was statistically significant [emotional/ indifference of NMSS;MD=--2.5,95%CI （-4.11,-0.89）,P=0.002;BDI- 11;MD=-1.19,95%CI （-230,--0.08）,P=0.04;AS; MD=-1.56,95% CI （-2.67,-0.45）,P=0.006;sleep/fatigue of NMSS：MD=-2.03,95% CI （-3.08,-0.98） ,P=0.001 ;PDQ-8：MD=-4.93,95 % CI （-6.79,-3.07）,P〈O.OOOO1;PDQ-39：MD=-3.52,95%CI （-5.25,-1.79）,P〈0.OO01].The study bias of PDSS-2 was too large. The results of SHAPS were not statistically significant [MD=-0.12,95%CI （-0.58,0.34）,P=0.61].Conclusion Rotigotine Transdermal Patch can effectively improve PD neuropsyehiatric symptoms and improve the quality of life of patients compared with the control group.The conclusion needs to be further studied.