二甲双胍联合多奈哌齐治疗阿尔茨海默病的临床效果

Clinical effect of Metformin combined with Donepezil in the treatment of Alzheimer′s disease

目的探讨二甲双胍联合多奈哌齐治疗阿尔茨海默病的临床效果。方法选取2017年1月至2020年12月上海交通大学医学院附属瑞金医院及2018年10月至2020年12月上海交通大学医学院附属瑞金医院舟山分院收治的117例阿尔茨海默病并代谢综合征(MetS)患者为研究对象。按照随机数字表法分为对照组(59例)和联合组(58例),对照组单用多奈哌齐治疗,联合组采用二甲双胍联合多奈哌齐治疗。比较两组患者的简易智力状态检查(MMSE)、蒙特利尔认知评估量表(MoCA)、阿尔茨海默病评定量表-认知部分(ADAS-Cog)评分差值、空腹血糖、胰岛素稳态评估(HOMA-IR)及不良反应发生情况。结果联合组的消化道系统不良反应发生率高于对照组,两组的心血管系统、神经系统不良反应发生率比较,差异无统计学意义(P>0.05)。两组患者的脱落情况比较,差异无统计学意义(P>0.05)。治疗后,联合组患者的空腹血糖及HOMA-IR均低于对照组,差异有统计学意义(P<0.05)。两组患者治疗前后组间、组内的MMSE评分、MoCA评分比较,差异均无统计学意义(P>0.05)。两组患者的ADAS-cog评分差值比较,差异均无统计学意义(P>0.05)。结论二甲双胍联合多奈哌齐治疗与多奈哌齐单药治疗相比较,未能明显改善MetS的阿尔茨海默病患者的认知功能,联合治疗对于认知衰退无进一步减缓作用,且会显著增加患者消化系统不良反应,仍需进一步探索。

Objective To investigate the clinical effect of Metformin combined with Donepezil in the treatment of Alzheimer's disease.Methods A total of 117 patients with Alzheimer's disease and metabolic syndrome(MetS)admitted to Ruijin Hospital,Shanghaijiao Tong University School of Medicine from January 2017 to December 2020 and Ruijin Hospital,Zhoushan Branch,Shanghai Jiaotong University School of Medicine from October 2018 to December 2020 were selected as the study subjects.According to random number table method,they were divided into control group(59 cases)and combination group(58 cases).The control group was treated with Donepezil alone,and the combination group was treated with Metformin combined with Donepezil.The score of the mini-mental state examination(MMSE),Montreal cognitive assessment(MoCA),scoring difference of Alzheimer's disease rating scale-cognitive component(ADAS-Cog),fasting blood glucose,insulin homeostasis assessment(HOMA-IR)and the incidence of adverse reactions between the two groups were compared.Results The incidence of adverse reactions in gastrointestinal system in combination group was higher than that in control group,and there was no statistical significance in the incidence of adverse reactions in cardiovascular system and nervous system between two groups(P>0.05).There was no statistical significance in shedding between the two groups(P>0.05).After treatment,fasting blood glucose and HOMA-IR of patients in combination group were lower than those in control group,with statistical significances(P<0.05).There were no significant differences in MMSE score and MoCA score between two groups before and after treatment(P>0.05).There was no statistical significance in the difference of ADAS-cog scores between the two groups(P>0.05).Conclusion Compared with Donepezil monotherapy,Metformin combined with Donepezil failed to significantly improve cognitive function in MetS patients with Alzheimer's disease.Combined therapy had no further slowing effect on cognitive decline and significantly increased digestive adverse reactions in patients,which still needs further exploration.