吡贝地尔联合左旋多巴治疗帕金森病的Meta分析

Meta-Analysis of Piribedil Combined with Levodopa for the Treatment of Parkinson's Disease

关键词:  帕金森病  吡贝地尔  左旋多巴  系统评价  Meta分析

Key words:  Parkinson's disease  piribedil  levodopa  systematic review  meta-analysis

摘要:

目的 系统评价吡贝地尔联合左旋多巴治疗帕金森病（Parkinson’s disease，PD）的有效性与安全性。方法 检索Cochrane library、PubMed、ScienceDirect英文数据库和CNKI、WanFang、VIP中文数据库，检索时间从建库至2015年9月，收集吡贝地尔联用左旋多巴治疗PD的随机对照试验（randomized controlled trial，RCT）。由2名研究者严格按照纳入与排除标准独立筛选文献、提取资料并评价质量，使用RevMan5.3软件进行Meta分析。结果 最终纳入9个随机对照试验，共计697例PD患者。Meta分析结果显示，吡贝地尔联合左旋多巴在改善统一帕金森病评定量表（unified Parkinson’s disease rating scale，UPDRS）总评分、UPDRS运动评分、UPDRS日常活动评分方面优于左旋多巴联合安慰剂或左旋多巴单药治疗，差异具有统计学意义[UPDRS总评分：MD=-9.20，95% CI（-11.28，-7.12），P<0.000 01；UPDRS运动评分：随访时间≤6月，MD=-3.04，95% CI（-4.92，-1.16），P=0.002；随访时间>6个月，MD=-10.81，95% CI（-14.76，-6.86），P<0.000 01；UPDRS日常活动评分：MD=-1.28，95% CI（-2.31，-0.26），P=0.01]；在胃肠道不良反应发生率方面，左旋多巴联合安慰剂或左旋多巴单药治疗优于吡贝地尔联合左旋多巴，其差异有统计学意义[OR=1.86，95% CI（1.04，3.31），P=0.04]。结论 吡贝地尔联用左旋多巴治疗PD，可显著改善UPDRS总评分、UPDRS运动评分、UPDRS日常活动评分，同时应重视其胃肠道不良反应。

Abstract:

OBJECTIVE To evaluate the safety and efficacy of piribedil combined with levodopa in the treatment of Parkinson's disease (PD). METHODS Randomized controlled trials of piribedil combined with levodopa for PD were gathered from Cochrane Library, PubMed, Science Direct, CNKI, WanFang and VIP from their establishment to September 2015. Two reviewers independently screened the studies, extracted the data and assessed the quality according to the inclusion and exclusion criteria. The Meta-analysis was conducted with RevMan 5.3 software. RESULTS A total of 9 randomized controlled trials (RCTs) involving 697 PD patients were included. The results of Meta-analysis showed that compare with placebo plus levodopa or levodopa, piribedil plus levodopa significantly greater improvements in total unified Parkinson's disease rating scale (UPDRS) scores, motor UPDRS scores and activities of daily living UPDRS scores in participants with PD with statistically differences[Total UPDRS scores:MD=-9.20, 95%CI(-11.28,-7.12), P<0.000 01; Motor UPDRS scores:Follow-up time was less than or equal to 6 months, MD=-3.04, 95%CI(-4.92, -1.16), P=0.002; Follow-up time was more than 6 months, MD=-10.81, 95%CI(-14.76, -6.86), P<0.000 01; activities of daily living UPDRS scores:MD=-1.28, 95%CI(-2.31, -0.26), P=0.01], and more gastrointestinal adverse events incidences with statistically differences[OR=1.86, 95%CI(1.04, 3.31), P=0.04]. CONCLUSION Piribedil in addition to levodopa is an effective combination therapy for PD, and significantly improvements in total UPDRS scores, motor UPDRS scores and activities of daily living UPDRS scores, and we should more focus on the gastrointestinal adverse events too.