美金刚联合多奈哌齐治疗中重度阿尔茨海默病的效果观察

Curative effect analysis of memantine and donepezil in the treatment of moderate to severe Alzheimer's disease

目的 探讨美金刚联合多奈哌齐治疗中、重度阿尔茨海默病的临床效果和安全性,为临床治疗提供依据.方法 收集112例中、重度阿尔茨海默病患者,将患者随机分为观察组(美金刚联合多奈哌齐治疗组)和对照组(美金刚治疗组),疗程分别为24周.分别于治疗前、后给予简易智能精神状态量表(MMSE)、阿尔茨海默病评估量表-认知部分(ADAS-cog)、阿尔茨海默病协作学习-日常生活能力问卷(ADCS-ADL)、神经精神科问卷(NPI)评分,并评价两种治疗方法的安全性和有效性.结果 观察组患者治疗后MMSE、ADAS-cog、ADL、NPI评分分别为(12.1±2.1)、(32.9±8.3)、(33.4±5.0)、(6.1±3.1)分,较治疗前(9.9±2.8)、(46.2±7.6)、(42.1±6.0)、(10.5±2.9)分均有明显改善,治疗前、后比较差异均有统计学意义(t值分别为2.138、-2.411、2.398、2.107,P均＜0.05);对照组患者治疗后MMSE、ADAS-cog、ADL、NPI评分分别为(12.3±2.6)、(33.1±7.2)、(35.1±6.6)、(6.7±2.9)分,较治疗前(11.0±2.5)、(44.9±6.9)、(42.2±6.6)、(10.9±3.5)分均有明显改善,治疗前、后比较差异均有统计学意义(t值分别为2.101、-2.033、2.105、2.400,P均＜0.05);两组患者治疗后MMSE、NPI评分比较差异有统计学意义(t值分别为2.553、2.176,P均＜0.05).观察组和对照组患者不良反应发生率分别为32.14％(18/56)、26.79％ (15/56),两组比较差异无统计学意义(P＞0.05).结论 美金刚联用多奈哌齐治疗中、重度阿尔茨海默病患者的效果明显优于单用美金刚的效果,且长期应用并不增加不良反应出现的风险,联合应用安全、有效.

Objective To investigate clinical efficacy and safety of the memantine and donepezil in the treatment of moderate to severe Alzheimer's disease,in order to provide the basis for clinical treatment.Methods One hundred and twelve cases of moderate to severe Alzheimer's disease patients were given memantine plus donepezil(observation group) ,and single use of memantine treatment(control group), and the treatment for 24 weeks.Respectively before and after treatment, Mini Mental State Scale (MMSE), Alzheimer' s disease assessment scale (ADAS-cog), Alzheimer' s disease collaborative learning, daily life ability questionnaire (ADCS-ADL) ,and neuropsychological questionnaire (NPI) score, and adverse reactions were observed in the process of two kinds of therapy, the efficacy and safety of two kinds of treatment methods were evaluated.Results After treatment, the patients in observation group with MMSE, ADAS-cog, ADL and NPI evaluation results were (12.1 ± 2.1), (32.9 ± 8.3), (33.4 ± 5.0), (6.1 ± 3.1) scores, significantly improved compared with scoring (9.9±2.8), (46.2±7.6), (42.1±6.0), (10.5±2.9) scores before treatment,and the differences were statistically significant (t =2.138,-2.411,2.398, 2.107 respectively, P ＜ 0.05).The control group after treatment in patients with MMSE, ADAS-cog, ADL and NPI evaluation results were (12.3±2.6), (33.1 ±7.2), (35.1 ±6.6), (6.7 ± 2.9) scores, significantly improved compared with scoring 11.0 ± 2.5,44.9 ± 6.9,42.2 ±6.6,10.9 ± 3.5 before treatment, and the difference had statistical significanc (t =2.101,-2.033,2.105, 2.400 respectively, P＜0.05).After treatment, the difference of patients in the two groups of MMSE, NPI score had statistical significance(t =2.553,2.176, P＜0.05).The adverse reactions in two group respectively were 32.14％ (18/56) and 26.79％ (15/56), less difference was no statistical significance (P＞0.05).Vital signs checks,regular laboratory examination and ECG examination showed no obvious abnormalities.Conclusion Memantine combined with donepezil in the treatment of moderate and severe AD patients is superior to the singleeffect of memantine, and long-term use will not increase the risk of adverse reactions, which is safe and effective in the combined application.