多奈哌齐联合尼莫地平治疗脑小血管病相关认知功能障碍有效性和安全性的Meta分析

Meta-analysis of the Efficacy and Safety of Donepezil in Combination with Nimodipine for Cognitive Dysfunction in Cerebral Small Vessel Disease

目的:系统性评价多奈哌齐联合尼莫地平治疗脑小血管疾病(cerebral small vessel disease,CSVD)所致认知功能障碍的有效性及安全性。方法:利用计算机检索中国生物医学文献数据库(China biology medicine disc,CBM)、维普中文科技期刊数据库(VIP data)、中国知网(China national knowledge infrastructure,CNKI)、万方数据库(Wanfang data)、PubMed、SCI-E引文数据库(Science Citation Index Expanded),收集多奈哌齐联合尼莫地平治疗CSVD认知功能障碍的随机对照试验(randomized controlled trial,RCT)。检索时限为建库起至2022年11月20日。选用Rev Man 5.4.1软件对评估后的研究资料进行Meta分析。结果:最终纳入8项RCT,包含741名患者。结果显示,多奈哌齐联合尼莫地平治疗的总有效率[RR=1.27,P<0.00001,95%CI(1.17,1.37)]、MoCA评分[MD=4.09,P<0.00001,95%CI(2.47,5.71)]、MMSE评分[MD=3.22,P=0.02,95%CI(0.42,6.02)]、Hcy[MD=-4.15,P<0.00001,95%CI(-4.46,-3.84)]、hs-CRP[MD=-1.17,P<0.00001,95%CI(-1.27,-1.06)]方面均优于单用多奈哌齐或尼莫地平,而不良反应之间无明显差异(RR=1.18,P=0.54,95%CI(0.69,2.03))。结论:多奈哌齐联合尼莫地平可以明显改善CSVD认知功能障碍,在总有效率、MoCA、MMSE、Hcy、hs-CRP方面较单用多奈哌齐或尼莫地平效果更好,且治疗安全性好。

Objective:To systematically evaluate the efficacy and safety of donepezil combined with nimodipine in the treatment of cognitive dysfunction caused by CSVD.Methods:Using computer search of CBM,VIP data,CNKI,Wanfang data and PubMed,we evaluated the effectiveness and safety of donepezil in combination with nimodipine in cognitive dysfunction caused by CSVD.The RCT of donepezil combined with nimodipine for CSVD cognitive dysfunction was collected from Wanfang data,PubMed,and SCI-E citation index expanded.The search period was from the date of database creation to November 20,2022.Rev Man 5.4.1 software was selected to perform Meta-analysis on the evaluated study data.Results:A total of 8 RCTs,containing 741 patients,were finally included.The results showed that the total effective rate[RR=1.27,P<0.00001,95%CI(1.17,1.37)],MoCA score[MD=4.09,P<0.00001,95%CI(2.47,5.71)],MMSE score[MD=3.22,P=0.02,95%CI(0.42,6.02)],Hcy[MD=-4.15,P<0.00001,95%CI(-4.46,-3.84)],and hs-CRP[MD=-1.17,P<0.00001,95%CI(-1.27,-1.06)]were superior to donepezil or nimodipine alone,while there was no significant difference between adverse effects[RR=1.18,P=0.54,95%CI(0.69,2.03)].Conclusion:Donepezil combined with nimodipine can significantly improve CSVD cognitive dysfunction,with better overall efficiency,MoCA,MMSE,Hcy,and hs-CRP than donepezil or nimodipine alone,and with good treatment safety.