丙戊酸盐治疗痴呆精神行为症状有效性和安全性的Meta分析

Efficacy and safety ofvalproatein treatment of behavioral and psychological symptoms of dementia (BPSD): Meta-analysis

目的:系统评价丙戊酸盐治疗痴呆精神行为症状的有效性和安全性。方法:计算机检索The Cochrane Library(2018年12期)、EMbase、PubMed、CNKI、CBM、VIP和WanFang Data数据库,搜集丙戊酸盐治疗痴呆精神行为症状的随机对照试验,检索时限均为建库至2018年12月。由两位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan5.3软件进行meta分析。结果:共纳入14个研究,累计患者1 043例,其中试验组501例,对照组542例。Meta分析结果显示:与对照组相比,丙戊酸盐组可显著提高NPI总评分[SMD=0.46,95%CI(0.21,0.72),P=0.0003],降低MMSE评分[SMD=-0.36,95%CI(-0.58,-0.15),P=0.001],差异具有显著性,同时不明显增加不良反应发生风险。结论:当前研究证据表明,在常规治疗痴呆精神行为症状的基础上,加用丙戊酸盐可明显改善痴呆患者的总体认知功能和精神行为症状,且安全性较好。因此,丙戊酸盐可作为心境稳定剂在临床合理用于痴呆精神行为症状患者。受纳入研究数量和质量的限制,上述结论尚需更多高质量研究予以验证。

OBJECTIVE To systematically review the efficacy and safety of Valproate in treatment of Behavioral and Psychological Symptoms of Dementia(BPSD).METHODS Cochrane Library,EMbase,PubMed,CNKI,CBM,VIP and WanFang data were searched for randomized controlled trials of valproate in the treatment of mental and behavioral symptoms of dementia.from inception to December 2018.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Then meta-analysis was performed using RevMan 5.3 software.RESULTS A total of 14 studies involving 1043 patients were included,of which 501 patients in the experimental group and 542 patients in the control group.The results of meta-analysis showed that,compared to the control group,the valproate group could significantly increase NPI(SMD=0.46,95%CI 0.21 to 0.72,P=0.0003)and reduce MMSE(SMD=-0.36,95%CI-0.58 to-0.15,P=0.001),with significant statistical significance,without significantly increasing the risk of adverse reactions.CONCLUSION The current evidence indicates that the valproate can significantly improve the general cognitive function and mental behavior symptoms of dementia based on routine treatment with a favorable safe profile.Therefore,valproate can be used as a mood stabilizer in patients with mental and behavioral symptoms of dementia.Due to limited quantity and quality of the included studies,more large scale and high quality studies are needed to verify the above conclusion.