美金刚联合多奈哌齐治疗阿尔茨海默病的有效性和安全性的系统评价

A Systematic Review of Efficacy and Safety of Memantine Combine with Donepezil in Alzheimer’s disease Treatment

目的:系统评价美金刚联合多奈哌齐治疗阿尔茨海默病(Alzheimer's disease,AD)的有效性和安全性。方法:计算机检索Medline、Embase、Cochrane Library、中国生物医学文献数据库(CBM),收集有关美金刚联合多奈哌齐治疗AD的随机对照试验(randomized controlled trials,RCTs),检索时限为建库至2018年1月。由两位评价者独立筛选文献、提取资料并评价纳入研究的质量后,采用RevMan5.3软件进行Meta分析。结果:共纳入9项RCTs,包括2316例患者。与单用多奈哌齐比较,联合治疗组能够改善AD患者的认知功能(MMSE:[SMD=0.38,95%CI(0.08,0.69),P=0.01]),日常生活能力(ADCS-ADL:[SMD=-0.40,95%CI(-0.76,-0.05),P=0.013])、行为和精神症状(NPI:[SMD=-2.16,95%CI(-3.14,-1.17),P<0.0001])。两组治疗后不良事件差异无统计学意义。结论:与单用多奈哌齐比较,美金刚联合多奈哌齐能够更好地改善阿尔茨海默患者的认知功能、行为与精神症状和日常生活能力,但是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研究予以验证。

Objective: To evaluate the efficacy and safety of memantine combined with donepezil in Alzheimer's disease (AD) treatment. Methods: Medline, EMbase, The Cochrane Library, CBM were searched to collect randomized controlled trials (RCTs) about memantine combined with donepezil in AD treatment from database building to January 2018.Two researchers independently screened literature, extracted data and evaluated the quality of the included studies. Then, Meta-analysis was performed by RevMan 5.3 software. Results: A total of 9 RCTs were included, including 2316 patients. Compared with monotherapy of donepezil, combination therapy group exhibited improvements in cognitive function(MMSE:[SMD=0.38,95%CI(0.08,0.69), P=0.01]),daily living activities (ADCS-ADL:[SMD=-0.40,95% CI (-0.76,-0.05), P=0.013]), behavioural and psychological symptoms (NPI:[SMD=-2.16, 95%CI (-3.14,-1.17), P< 0.0001]).There was no significant difference between the two groups in the number of adverse events. Conclusions: Donepezil combined with memantine led to greater improvement in cognitive functions,daily living activities and behavioural and psychological symptoms than donepezil alone. Due to the limited quantity and quality of included studies, the above conclusions are still needed to be verified by more high quality studies.