利培酮对比氟哌啶醇治疗老年痴呆精神行为症状有效性和安全性的Meta分析
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篇名: 利培酮对比氟哌啶醇治疗老年痴呆精神行为症状有效性和安全性的Meta分析
TITLE:
摘要: 目的:系统评价利培酮对比氟哌啶醇治疗老年痴呆精神行为症状的有效性和安全性,为临床用药提供循证参考。方法:计算机检索Cochrane图书馆、PubMed、Embase、中国知网、中国生物医学文献数据库、万方数据库和维普数据库,收集利培酮(试验组)对比氟哌啶醇(对照组)治疗老年痴呆精神行为症状的随机对照试验(RCT)。筛选文献、提取资料,采用Cochrane系统评价员手册5.1.0偏倚风险评估工具对纳入文献进行质量评价后,采用Rev Man 5.3软件进行Meta分析。结果:共纳入26项研究,共计2 219例患者。Meta分析结果显示,试验组患者总有效率 [RR=1.11,95%CI(1.05,1.18),P=0.000 3]、激越问卷评分[SMD=0.19,95%CI(0.04,0.34),P=0.01]均显著高于对照组,简易智力状态检查量表评分[SMD=-0.32,95%CI(-0.63,-0.01),P=0.04]以及锥体外系反应[RR=0.39,95%CI(0.31,0.49),P<0.000 1]、胃肠道反应[RR=0.51,95%CI(0.38,0.68),P<0.000 1]、嗜睡[RR=0.47,95%CI(0.25,0.88),P=0.02]、口干[RR=0.50,95%CI(0.33,0.74),P=0.000 5]、便秘[RR=0.33,95%CI(0.20,0.54),P<0.000 1]的发生率均显著低于对照组;两组患者阿尔茨海默病行为病理评定量表评分 [SMD=0.03,95%CI(-0.09,0.16),P=0.62]以及失眠[RR=1.26,95%CI(0.76,2.11),P=0.37]、头痛/头晕[RR=0.65,95%CI(0.38,1.12),P=0.12]、心动过速[RR=0.40,95%CI(0.12,1.31),P=0.13]的发生率比较,差异均无统计学意义。结论:利培酮治疗老年痴呆精神行为症状的疗效和安全性均显著优于氟哌啶醇,而且可改善患者的激越行为和总体认知功能。
ABSTRACT: OBJECTIVE: To systematically evaluate the efficacy and safety of risperidone versus haloperidol in the treatment of behavioral and psychological symptoms of dementia (BPSD), and to provide evidence-based reference for clinical drug use. METHODS: Cochrane library, PubMed, EMbase, CNKI, CBM, Wanfang and VIP database were searched for the randomized controlled trials (RCT) on risperidone (trial group) versus haloperidol (control group) in the treatment of BPSD. After literature screening, data extraction and quality evaluation with Cochrane system evaluator manual 5.1.0, Meta-analysis was performed by using Rev Man 5.3 software. RESULTS: A total of 26 studies were included, involving 2 219 patients. The results of Meta-analysis showed that the total response rate [RR=1.11, 95%CI(1.05, 1.18), P=0.000 3] and CMAI score [SMD=0.19, 95%CI(0.04, 0.34), P=0.01] in trial group were significantly higher than control group. MMSE score [SMD=-0.32, 95%CI(-0.63, -0.01), P=0.04], and the incidence of extrapyramidal reaction [RR=0.39, 95%CI(0.31, 0.49), P<0.000 1], gastrointestinal reaction [RR=0.51, 95%CI(0.38, 0.68), P<0.000 1], somnolence [RR=0.47, 95%CI (0.25, 0.88), P=0.02], thirst [RR=0.50, 95%CI(0.33, 0.74), P=0.000 5] and constipation [RR=0.33, 95%CI(0.20, 0.54), P<0.000 1] in trial group were significantly lower than control group. There were no statistical significance in BEHAVE-AD score [SMD=0.03, 95%CI(-0.09,0.16), P=0.62] and the incidence of insomnia [RR=1.26, 95%CI(0.76, 2.11), P=0.37], headache/dizziness [RR=0.65, 95%CI(0.38, 1.12), P=0.12] and tachycardia[RR=0.40, 95%CI(0.12, 1.31), P=0.13] between two groups. CONCLUSIONS: The efficacy and safety of risperidone in the treatment of BPSD are signi- ficantly better than haloperidol, and risperidone can improve agitation behavior and general cognitive state of patients.
期刊: 2019年第30卷第24期
作者: 石宇,田方圆,李海霞,秦舟,徐珽
AUTHORS: SHI Yu,TIAN Fangyuan,LI Haixia,QIN Zhou,XU Ting
关键字: 利培酮;氟哌啶醇;老年;痴呆精神行为症状;疗效;安全性;Meta分析
KEYWORDS: Risperidone; Haloperidol; Elderly; Behavio- ral and psychological symptoms; Efficacy; Safety; Meta- analysis
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