胆碱酯酶抑制阿尔茨海默病:他克林试验的荟萃分析。痴呆实验合作。

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Qizilbash N,怀特黑德,希金斯J -威尔科克G,施耐德L,大学法洛米

胆碱酯酶抑制阿尔茨海默病:他克林试验的荟萃分析。痴呆实验合作。

《美国医学协会杂志》上。1998年11月25日,280 (20):1777 - 82。

PubMed ID
9842955 (在PubMed
]
文摘

目的:测定胆碱酯酶抑制的影响与盐酸他克林阿尔茨海默病的症状在认知能力方面,临床全球印象,行为,和功能的自治权。数据来源:Cochrane痴呆组注册表的试验。研究选择:Unconfounded,随机、双盲、安慰剂对照试验中,给他克林超过1天,1月1日之前完成1996。数据提取:两个评论者独立选择试验所获得的包容和个体患者数据。数据综合:12个试验的数据进行了分析,其中包括1984名患有阿尔茨海默病。在12周,认知能力,以细微精神状态检查(分数范围,0 30),是更好的比接受安慰剂的病人在接受他克林的病人中0.62(95%可信区间[CI], 0.23 - -1.00;P = .002)。相比具有类似未经治疗的患者会恶化由0.50到1.00点细微精神状态检查12周期间,患者的进步他克林将改善之间的0.12和0.38分的恶化。改进的优势比变化的全球临床印象规模(范围1 - 7)患者接受他克林与接受安慰剂为1.58 (95% CI, 1.18 - -2.11;P = .002)。 The behavioral noncognitive subscale of the Alzheimer's Disease Assessment Scale (range, 0-50) showed a difference in favor of tacrine of 0.58 points (95% CI, 0.17-1.00; P= .006). Improvement on the Progressive Deterioration Scale, largely an index of functional activities, was not significant (0.75; 95% CI, -0.43 to 1.93; P=.21). Age, severity of dementia, and exposure to tacrine prior to randomization had no clear influence on the treatment effect. There was a nonsignificant trend toward increasing effect with increasing dose for cognitive function and the Clinical Global Impression of Change. For patients without prior exposure to tacrine, the odds of patients' withdrawing during the study while they were receiving tacrine compared with placebo was 3.63 (95% CI, 2.80- 4.71; P<.001). Eleven (95% CI, 7-31) patients would need to be treated to achieve any improvement on the Clinical Global Impression scale, and 42 (95% CI, 23-125) to achieve a moderate or marked improvement. One patient would be expected to withdraw for every 4 (95% CI, 3-5) patients treated. CONCLUSIONS: Cholinesterase inhibition with tacrine appears to reduce deterioration in cognitive performance during the first 3 months and increase the odds of global clinical improvement. Effects observed on measures of behavioral disturbance were of questionable clinical significance, and functional autonomy was not significantly affected. The clinical relevance of the benefits of cholinesterase inhibition remains controversial, and long-term trials with clinically relevant end points are required.

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