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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、Pub Med、Science Direct英文数据库和CNKI、Wan Fang、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Rev Man5.3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’sdisease 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。
Objective To evaluate the efficacy and safety of piperidil combined with levodopa in the treatment of Parkinson’s disease (PD). Methods The randomized controlled trials (CTP) of Cochrane Library, Pub Med, Science Direct and CNKI, Wan Fang and VIP Chinese databases were performed to retrieve PD from piracetam to september 2015 randomized controlled trial, RCT). Two researchers independently screened the literature strictly according to inclusion and exclusion criteria, extracted data and evaluated quality, and used Meta-analysis using RevMan5.3 software. The results eventually included 9 randomized controlled trials, a total of 697 cases of PD patients. Meta-analysis showed that the combination of piribedil and levodopa was superior to levodopa in improving the total score of the unified Parkinson’s disease rating scale (UPDRS), UPDRS score, UPDRS daily activity score Placebo or levodopa monotherapy, the difference was statistically significant [UPDRS total score: MD =? 9.20, 95% CI (? 11.28,? 7.12), P <0.000 01; UPDRS motor score: follow-up time ≤ 6 months , MD =? 3.04, 95% CI (? 4.92,? 1.16), P = 0.002; Follow-up time> 6 months, MD =? 10.81, 95% CI Daily activity score: MD =? 1.28, 95% CI (? 2.31,? 0.26), P = 0.01]; Levodopa combined with placebo or levodopa alone was superior to monotherapy in the incidence of gastrointestinal adverse reactions The differences were statistically significant (P <0.01). The odds ratio was 1.86, 95% CI (1.04, 3.31), P = 0.04]. Conclusions Piracetam combined with levodopa in the treatment of PD can significantly improve the UPDRS total score, UPDRS exercise score, UPDRS daily activity score, and should pay attention to its gastrointestinal adverse reactions.