Zhongguo cuzhong zazhi (Oct 2023)
血管性帕金森综合征药物治疗的疗效与安全性：基于随机对照试验的网状meta分析 Objective To assess the efficacy and safety of drug treatment of vascular parkinsonism (VP) using network meta-analysis.
Abstract
目的 运用网状meta分析探讨血管性帕金森综合征（vascular parkinsonism，VP）药物治疗的疗效及安全性。 方法 计算机检索中国知网、万方数据知识服务平台、维普中文期刊服务平台、PubMed、Web of Science、MEDLINE、Embase、Cochrane Library收录的VP药物治疗的随机对照试验，检索时限为各数据库建库至2023年1月1日。由两名研究员独立进行文献筛选、数据提取并对纳入的研究进行质量评价，应用R软件对数据进行网状meta分析。 结果 最终纳入20项研究，包括丁苯酞联合多巴丝肼、依达拉奉联合多巴丝肼、盐酸普拉克索联合多巴丝肼、单用多巴丝肼4种药物疗法。总体文献质量水平中等。网状meta分析结果显示：①在治疗总有效率方面，优选概率排名曲线（surface under the cumulative ranking curve，SUCRA）排序结果显示，丁苯酞联合多巴丝肼＞依达拉奉联合多巴丝肼＞盐酸普拉克索联合多巴丝肼＞单用多巴丝肼；②在帕金森病统一评分量表（unified Parkinson’s disease rating scale，UPDRS）评分改善方面，SUCRA排序结果显示，丁苯酞联合多巴丝肼＞依达拉奉联合多巴丝肼＞盐酸普拉克索联合多巴丝肼＞单用多巴丝肼；③在不良反应方面，SUCRA排序结果显示，丁苯酞联合多巴丝肼＞单用多巴丝肼＞盐酸普拉克索联合多巴丝肼＞依达拉奉联合多巴丝肼。 结论 丁苯酞联合多巴丝肼治疗VP的有效率最高，对UPDRS评分改善最明显，且安全性最好，未观察到有明显增加不良反应的风险。但纳入的研究方法学质量普遍偏低，故结论仍待更多大样本、高质量的研究进一步验证。 Abstract: Objective To assess the efficacy and safety of drug treatment of vascular parkinsonism (VP) using network meta-analysis. Methods A computerized search of randomized controlled trials of VP drug treatment in CNKI, Wanfang, VIP, PubMed, Web of Science, MEDLINE, Embase, and Cochrane Library was conducted from the inception each database to January 1, 2023. Two researchers independently performed literature screening, data extraction, and quality evaluation of the included studies. R was applied to perform a network meta-analysis of the data. Results Twenty studies were included, including butylphthalide in combination with levodopa, edaravone in combination with levodopa, pramipexole dihydrochloride in combination with levodopa and levodopa alone. The overall literature quality level is medium. The results of the network meta-analysis showed that: (1) in terms of total treatment effectiveness, the surface under the cumulative ranking curve (SUCRA) showed that butylphthalide in combination with levodopa > edaravone in combination with levodopa > pramipexole dihydrochloride in combination with levodopa > levodopa alone. (2) In terms of unified Parkinson's disease rating scale (UPDRS) scores, the SUCRA showed that butylphthalide in combination with levodopa > edaravone in combination with levodopa > pramipexole dihydrochloride in combination with levodopa > levodopa alone. (3) In terms of adverse reactions, the SUCRA showed that butylphthalide in combination with levodopa > levodopa alone > pramipexole dihydrochloride in combination with levodopa > edaravone in combination with levodopa. Conclusions Butylphthalide in combination with levodopa had the highest efficiency, the most significant improvement in UPDRS scores, and the best safety profile for the treatment of VP, and no significant increased risk of adverse effects was observed. However, the methodological quality of the included studies was generally low, so the conclusions remain to be further validated by studies with larger samples and high quality.
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