【作者】 张丹丹；

【导师】 邵延坤；

【作者基本信息】 吉林大学 ， 神经病学（专业学位）， 2019， 硕士

【摘要】 目的:比较奥氮平与利培酮治疗痴呆精神行为症状的疗效及安全性。方法:应用计算机全面检索CNKI、CBM、维普、万方、Pubmed、Cochrane Library、Embase等数据库,检索词包括目标疾病、干预措施、对照措施,具体检索词根据不同数据库做相应调整。限制时间从建库到2019年2月,语言为中文或英文。严格按照制定的纳入及排除标准对文献进行筛选剔除,应用风险评估工具对文献进行质量评价,提取文献相关数据,采用ReMan5.3统计学软件对纳入的文献数据进行Meta分析,针对本研究的连续型变量和二分类变量分别选用标准化均数差(SMD)、加权均数差(WMD)和比值比(OR)作为效应指标,以I~2统计量衡量异质性大小,当I~2<50%时,认为各研究间异质性较小,采用固定效应模型(Fixed effect model,FE)计算合并统计量,否则认为研究数据间存在异质性,采用随机效应模型(Random effect model,RE)计算合并统计量,进而评价两种药物的疗效及安全性。结果:本研究最终纳入12篇文献,在疗效方面,统计学分析各研究治疗结束时疗效评价指标(NPI、BEHAVE-AD),结果:P=0.63,SMD=-0.03,95%CI(-0.14,0.08),差异无统计学意义。以NPI为疗效评价指标的亚组分析结果:P=0.82,WMD=-0.41,95%CI(-4.01,3.19),差异无统计学意义。以BEHAVE-AD为疗效评价指标的亚组分析结果:P=0.41,WMD=-0.37,95%CI(-1.24,0.51),差异无统计学意义。进一步分析治疗2周时疗效评价指标,结果:P=0.25,SMD=-0.09,95%CI(-0.25,0.07),差异无统计学意义。在安全性方面,嗜睡不良反应结果:P=0.03,OR=1.53,95%CI(1.05,2.24),嗜睡不良反应奥氮平组发生率高于利培酮组。锥体外系症状不良反应结果:P<0.0001,OR=0.35,95%CI(0.21,0.57),椎体外系不良反应奥氮平组发生率低于利培酮组。乏力不良反应结果:P=0.99,OR=1.00,95%CI(0.58,1.72),差异无统计学意义。激惹不良反应结果:P=0.98,OR=1.00,95%CI(0.67,1.49),差异无统计学意义。结论:奥氮平与利醅酮治疗痴呆精神行为症状在疗效方面无明显差异,在安全性方面奥氮平嗜睡不良反应发生率高于利培酮,锥体外系症状不良反应发生率低于利培酮。更多还原

【Abstract】 Purpose:To compare the efficacy and safety of olanzapine and risperidone in the treatment of behavioral and psychological symptoms of dementias.Method:The computer is used to comprehensively search databases such as CNKI,CBM,Weipu,Wanfang,Pubmed,Cochrane Library,and Embase.The search terms include target diseases,interventions,and control measures.The specific search terms are adjusted according to different databases.Restricted time from building the library to February 2019,the language is Chinese or English.The literature was selected and excluded in strict accordance with the established inclusion and exclusion criteria.The risk assessment tool was used to evaluate the quality of the literature,and the relevant data of the literature were extracted.The data of the included literature were analyzed by ReMan5.3 statistical software.The typed variable and the second categorical variable were selected as the effect index by the standardized mean difference(SMD),the weighted mean difference(WMD)and the odds ratio(OR),and the heterogeneity was measured by the I~2 statistic.When I~2<50%It is considered that the heterogeneity between the studies is small,and the combined effect is calculated by the fixed effect model(FE).Otherwise,the heterogeneity between the research data is considered,and the random effect model(RE)is used to calculate the merger.Statistics,in turn,evaluate the efficacy and safety of the two drugs.Result:This study finally included 12 articles.In terms of efficacy,statistical analysis of the efficacy evaluation indicators(NPI,BEHAVE-AD)at the end of treatment,the results:P=0.63,SMD=-0.03,95%CI(-0.14,0.08),the difference was not statistically significant.Subgroup analysis results of NPI as efficacy evaluation index:P=0.82,WMD=-0.41,95%CI(-4.01,3.19),the difference was not statistically significant.The subgroup analysis results of BEHAVE-AD as efficacy evaluation index:P=0.41,WMD=-0.37,95%CI(-1.24,0.51),the difference was not statistically significant.The results of the efficacy evaluation index at 2weeks of treatment were further analyzed:P=0.25,SMD=-0.09,95%CI(-0.25,0.07),and the difference was not statistically significant.In terms of safety,The results of somnolence adverse reactions:P=0.03,OR=1.53,95%CI(1.05,2.24),and the incidence of olanzapine was higher than that of the risperidone group.The results of extrapyramidal symptoms adverse reactions:P<0.0001,OR=0.35,95%CI(0.21,0.57),and the incidence of olanzapine was lower than that of the risperidone group.The results of weakness adverse reactions:P=0.99,OR=1.00,95%CI(0.58,1.72),the difference was not statistically significant.The results of irritation adverse reactions:P=0.98,OR=1.00,95%CI(0.67,1.49),and the difference was not statistically significant.Conclusion:There was no significant difference in the efficacy between olanzapine and risperidone in the treatment of behavioral and psychological symptoms of dementias.In terms of safety,the incidence of olanzapine adverse reactions was higher than that of risperidone,and the incidence of extrapyramidal adverse reactions was lower than that of risperidone.更多还原