多巴丝肼联合普拉克索治疗帕金森病有效性和安全性的Meta分析  

Efficacy and safety of levodopa/benserazide combined with pramipexole in Parkinson’s disease:a meta-analysis

作　　者：张艳[1] 戴昕妤 汤忠泉 欧婷[2] 赵晓敏[2] 陈先华 姚菁青 田雪 戴悦 黄柳 李云涛[2] ZHANG Yan;DAI Xin-yu;TANG Zhong-quan;OU Ting;ZHAO Xiao-min;CHEN Xian-hua;YAO Jing-qing;TIAN Xue;DAI Yue;HUANG Liu;LI Yun-tao(Department of Neurology,the Second Affiliated Hospital of Nanjing Medical Uinversity,Nanjing,Jiangsu 210011,China;不详)

机构地区：[1]南京医科大学第二临床医学院,江苏南京210011 [2]南京医科大学第二附属医院全科医学科,南京医科大学全科医学研究中心,江苏南京210011

出　　处：《中华全科医学》2020年第12期2106-2111,共6页Chinese Journal of General Practice

基　　金：江苏省“六大人才高峰”高层次人才C类资助项目(2016-WSN-080);江苏省高层次卫生人才“六个一工程”资助项目(LGY2016019);江苏省卫计委十三五“科教强卫工程”青年医学重点人才资助项目(QNRC2016677)。

摘　　要：目的系统评价多巴丝肼联合普拉克索治疗帕金森病(PD)的有效性与安全性。方法计算机检索PubMed、Cochrane library、中国知网、维普、万方数据库,收集采用多巴丝肼联合普拉克索治疗PD的随机对照试验。应用RevMan 5.3软件进行Meta分析。结果最终纳入30个随机对照试验,共3041例PD患者。Meta分析显示:多巴丝肼联合普拉克索治疗PD患者总有效率比对照组更高(OR=5.05,95%CI:3.75~6.78,P<0.01);可显著降低统一帕金森病评定量表(unified parkinson disease rating scale,UPDRS)总评分、UPDRS第Ⅱ部分评分(UPDRSⅡ)和UPDRS第Ⅲ部分评分(UPDRSⅢ),试验组与对照组之间差异均有统计学意义(MD=-7.31,95%CI:-9.74^-4.89,P<0.01;MD=-2.23,95%CI:-3.17^-1.30,P<0.01;MD=-4.88,95%CI:-6.01^-3.74,P<0.01),表明多巴丝肼联合普拉克索对PD的整体改善、生活质量改善、运动症状改善方面具有显著疗效。安全性分析表明,多巴丝肼联合普拉克索组同单用多巴丝肼组比较在治疗过程中患者恶心呕吐、低血压、头晕、嗜睡、失眠等不良反应发生率比较差异无统计学意义(均P>0.05);但联合用药组幻觉的发生率增加(OR=4.03,95%CI:1.37~11.87,P=0.01)。结论多巴丝肼联合普拉克索治疗PD的疗效显著,对患者UDPRS评分有明显改善作用,且安全性较高。Objective To systematically evaluate the efficacy and safety of levodopa/benserazide combined with pramipexole in the treatment of Parkinson’s disease(PD).Methods Randomised control trials(RCTs)of levodopa/benserazide combined with pramipexole for treating PD patients were searched from computerised databases,including PubMed,Cochrane Library,Chinese National Knowledge Infrastructure database(CNKI),VIP database for chinese technical periodical(VIP)and Wanfang Data.According to the included and excluded criterias,Meta-analysis was performed using Review Manager 5.3 software.Results Thirty trials with 3041 patients were included.The Meta-analysis showed that compared with levodopa/benserazide alone,levodopa/benserazide combined with pramipexole could significantly improve the overall efficacy of clinical treatment[OR=5.05,95%CI:(3.75,6.78),P<0.01],at the same time,decrease the scores of UPDRS total[MD=-7.31,95%CI:(-9.74,-4.89),P<0.01].UPDRS partⅡ[MD=-2.23,95%CI:(-3.17,-1.30),P<0.01]and UPDRS partⅢ[MD=-4.88,95%CI:(-6.01,-3.74),P<0.01].The results show that levodopa/benserazide combined with pramipexole significantly improved the overall of PD,quality of life and motor symptoms.Safety analysis showed that the incidence of adverse reactions such as nausea and vomiting,hypotension,dizziness,drowsiness and insomnia in patients of levodopa/benserazide combined with pramipexole group were not decreased compared with that in levodopa/benserazide alone(all P>0.05).However,the incidence of hallucination was increased in the combination group[OR=4.03,95%CI:(1.37,11.87),P=0.01],and the difference was statistically significant.Conclusion The treatment of levodopa/benserazide combined with pramipexole for PD has better curative effect,which can significantly improve the UDPRS score of patients,and the safety is reliable.

关 键 词：多巴丝肼 普拉克索 帕金森病 META分析 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R971[医药卫生—临床医学]