美金刚治疗阿尔茨海默病精神行为症状疗效及安全性的系统评价

Efficacy and safety of memantine in the treatment of behavioral and psychological symptoms of Aizheimer disease： a systematic review

目的系统评价美金刚治疗阿尔茨海默病（AD）精神行为症状（BPSD）的疗效和安全性。方法计算机检索Medline、Embase、CochraneLibrary（CENTRAL）、中国生物医学文献数据库（CBMdisc）、中文科技期刊数据库（VIP）和中国期刊全文数据库（CNKI），收集有关美金刚治疗AD的BPSD的随机对照试验（RCTs），检索时限为建库至2018年2月。由两位评价者独立筛选文献、提取资料并评价纳人研究的质量后，采用RevMan5．3软件进行Meta分析。结果共纳入12项RCTs，包括3982例患者。研究组采用美金刚治疗，对照组采用安慰剂治疗。Meta分析结果表明，美金刚能改善AD患者神经精神量表（NPI）评分（SMD=-0．11，95％CI=-0．17--0．04，P=0．001）。两组治疗后脱落例数和不良事件差异无统计学意义；两组嗜睡、血压升高、体重增加的发生率差异有统计学意义。结论美金刚能够改善AD患者BPSD，具有较好安全性，但注意嗜睡、血压升高、体重增加的不良事件。受纳入研究的数量和质量限制，上述结论尚需开展更多高质量的研究予以验证。

Objective To systematically evaluate the efficacy and safety of memantine in the treatment of behavioral and psychological symptoms of dementia （BPSD） in Alzheimer disease （AD）. Methods Randomized controlled trials （RCTs） on methadone for AD in BPSD were collected and retrieved from the databases of Medline, Embase, Cochrane Library （CENTRAL）, CBMdisc, VIP and CNKI until February 2018. Two researchers independently screened literature, extracted data and evaluated the quality of the included studies. Then, Meta-analysis was performed using RevMan 5.3 software. Results A total of 12 RCTs were included, involving 3 982 patients. Patients in study group were treated with memantine and patients in contrd group were treated with placebo. Meta-analysis showed that memantine can improve the Neuropsychiatric Inventory （NPI）score of AD patients （SMD=-O.I 1, 95%CI=-0.17- -0.04, P=0.001）. There was no statistical difference between the two groups in the number of withdrawn and adverse events after treatment. The differences in the incidence of somnolence, hypertension and weight increased between the two groups were statistically significant. Conclusions Memantine can improve BPSD in AD patients, with good safety. However attention should be paid to the adverse events, including somnolence, hypertension and weight increased. Due to the limitation of quantity and quality of the included studies, the above conclusions are still needed to be verified with more high quality studies.