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阿尔茨海默病药物治疗临床证据评价

Evaluation of medication treatment for Alzheimer’s disease on clinical evidence

【作者】 李梦秋张文武陈涛刘凌

【Author】 LI Meng-qiu;ZHANG Wen-wu;CHEN Tao;LIU Ling;Department of Neurology, West China Hospital, Sichuan University;

【机构】 四川大学华西医院神经内科

【摘要】 目的评价阿尔茨海默病不同药物治疗方案之疗效和不良反应,从循证医学角度为制定最佳治疗方案提供依据。方法分别以阿尔茨海默病(Alzheimer’s disease)、多奈哌齐(donepezil)、卡巴拉汀(rivastigmine)、加兰他敏(galantamine)、美金刚(memantine)、罗格列酮(rosiglitazone)等中英文词组为检索词,检索美国国立医学图书馆(PubMed)、英国Cochrane图书馆、万方数据知识服务平台学术期刊库和中国知网中国期刊全文数据库并辅助手工检索,获得阿尔茨海默病药物治疗相关系统评价、随机对照试验、临床对照试验和病例观察研究,采用Jadad量表对文献质量进行评价。结果经筛选共纳入阿尔茨海默病药物治疗相关文献33篇(系统评价14篇、随机对照临床试验14篇、临床对照试验4篇、病例观察研究1篇)。其中28篇为高质量文献,评分分别为4分(12篇)、5分(10篇)和7分(6篇);5篇为低质量文献,评分为3分。药物疗效及安全性评价显示:(1)阿尔茨海默病药物治疗以症状性治疗为主,多奈哌齐、卡巴拉汀、加兰他敏、美金刚均能改善患者认知功能,且安全性和耐受性良好,但不能影响疾病之病理进程。(2)疾病调节药物可以影响疾病潜在的病理生理学进程,已作为新型药物进入临床试验,为促进治疗方式的转变和更好地改善患者预后提供了线索。结论借助循证医学方法可以为阿尔茨海默病药物治疗提供最佳临床证据。

【Abstract】 Objective To formulate the best treatment plan for Alzheimer’s disease patients byevaluating the therapeutic efficacy and side effect of various evidence- based programs.Methods Alzheimer’s disease, donepezil, rivastigmine, galantamine, memantine, rosiglitazone, etc. were defined asretrieval words. PubMed, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure(CNKI) databases were used with applying of manual searching. Systematic reviews, randomized controlledtrials(RCT), controlled clinical trials and case-observation studies were collected and evaluated by JadadScale.ResultsAfter screening, 33 selected resources included 14 systematic reviews, 14 randomizedcontrolled trials, 4 controlled clinical trials and 1 case-observation study. According to Jadad Scale, total28 articles were evaluated to be high quality(12 with score 4, 10 score 5, 6 score 7), and 5 were lowquality with score 3. It was summarized as follows: 1) Alzheimer’s disease is a progressiveneurodegenerative disease for which no cure exists. To date, only symptomatic treatments withcholinesterase inhibitors(donepezil, rivastigmine, galantamine) and an N- methyl- D- aspartate(NMDA)receptor noncompetitive antagonist(memantine), are effective and well tolerated to counterbalance theneurotransmitter disturbance, but cannot limit or impact on disease progression. 2) Disease modifying drugis an potential agent, with persistent effect on slowing the progression of structural damage, and can bedetected even aCfter withdrawing the treatment. Many types of disease modifying drugs are undergoingclinical trials.onclusionsUsing evidence-based medicine methods can provide best clinical evidenceon Alzheimer’s disease treatment.

【关键词】 阿尔茨海默病; 药物疗法; 循证医学;

【Key words】 Alzheimer disease; Drug therapy; Evidence-based medicine;

【分类号】R749.16;R453;R499.1;

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