司来吉兰联合左旋多巴治疗帕金森病的Meta分析

Meta-analysis of Selegiline Combined with Levodopa for Parkinson’s Disease

关键词:  帕金森病  司来吉兰  左旋多巴  系统评价  Meta分析

Key words:  Parkinson’s disease  selegiline  levodopa  systematic review  Meta-analysis

摘要:

目的 系统评价司来吉兰联用左旋多巴治疗帕金森病(Parkinson’s disease，PD)的有效性与安全性。方法 检索英文数据库：Cochrane library、PubMed和中文数据库：CNKI、WanFang、VIP，检索时间从建库至2014年11月，收集司来吉兰联用左旋多巴治疗PD的随机对照试验。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后，使用RevMan5.3软件进行Meta分析。结果 最终纳入5个随机对照试验，共计1 158例PD患者。Meta分析结果显示：司来吉兰联合左旋多巴在改善帕金森病综合评分量表(unified Parkinson’s disease rating scale，UPDRS)总评分、UPDRS运动评分、Webster评分方面优于单用左旋多巴，且有显著性差异[UPDRS总评分：MD=-5.29，95%CI(-7.65，-2.94)，P<0.000 1；UPDRS运动评分：MD=-3.57，95%CI(-5.32，-1.82)，P<0.000 1；Webster评分：MD=-4.99，95%CI(-7.15，-2.83)，P<0.000 01]；在死亡率、不良反应发生率方面相当，其差异无统计学意义[死亡率：OR=1.23，95%CI(0.89，1.69)，P=0.22；不良反应：OR=1.10，95%CI(0.77，1.57)，P=0.60]。 结论 本研究结果表明，司来吉兰联用左旋多巴治疗PD，可显著改善UPDRS总评分、UPDRS运动评分和Webster评分，且安全可靠。

Abstract:

OBJECTIVE To evaluate the safety and efficacy of selegiline combined with levodopa in the treatment of Parkinson’s disease(PD). METHODS Random controlled trails of selegiline combined with levodopa for PD were gathered from Cochrane Library, PubMed, CNKI, WanFang and VIP from their establishment to November 2014. 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 5 randomized controlled trials (RCTs) involving 1 158 PD patients were included. The results of Meta-analysis showed that compared with levodopa used alone, the total UPDRS scores, motor UPDRS scores and Webster scores of selegiline combined with levodopa were significantly better[total UPDRS scores: MD=-5.29, 95%CI(-7.65, -2.94), P<0.000 1; motor UPDRS scores: MD=-3.57, 95%CI(-5.32, -1.82), P<0.000 1; Webster scores: MD=-4.99, 95%CI(-7.15, -2.83), P<0.000 01]. There were no significant differences of the death incidences and adverse events incidences[death incidences: OR=1.23, 95%CI(0.89, 1.69), P=0.22; adverse events incidences: OR=1.10, 95%CI(0.77, 1.57), P=0.60]. CONCLUSION Selegiline combined with levodopa is for treating PD, and significantly improves the total UPDRS scores, motor UPDRS scores and Webster scores based on this systematic review.