摘要： 目的 评价阿尔茨海默病不同药物治疗方案之疗效和不良反应，从循证医学角度为制定最佳治疗方案提供依据。方法 分别以阿尔茨海默病（Alzheimer's disease）、多奈哌齐（donepezil）、卡巴拉汀（rivastigmine）、加兰他敏（galantamine）、美金刚（memantine）、罗格列酮（rosiglitazone）等中英文词组为检索词，检索美国国立医学图书馆（PubMed）、英国Cochrane 图书馆、万方数据知识服务平台学术期刊库和中国知网中国期刊全文数据库并辅助手工检索，获得阿尔茨海默病药物治疗相关系统评价、随机对照试验、临床对照试验和病例观察研究，采用Jadad 量表对文献质量进行评价。结果 经筛选共纳入阿尔茨海默病药物治疗相关文献33 篇（系统评价14 篇、随机对照临床试验14 篇、临床对照试验4 篇、病例观察研究1 篇）。其中28 篇为高质量文献，评分分别为4 分（12 篇）、5 分（10 篇）和7 分（6 篇）；5 篇为低质量文献，评分为3 分。药物疗效及安全性评价显示：（1）阿尔茨海默病药物治疗以症状性治疗为主，多奈
哌齐、卡巴拉汀、加兰他敏、美金刚均能改善患者认知功能，且安全性和耐受性良好，但不能影响疾病之病理进程。（2）疾病调节药物可以影响疾病潜在的病理生理学进程，已作为新型药物进入临床试验，为促进治疗方式的转变和更好地改善患者预后提供了线索。结论 借助循证医学方法可以为阿尔茨海默病药物治疗提供最佳临床证据。

关键词: 阿尔茨海默病, 药物疗法, 循证医学

Abstract: Objective  To formulate the best treatment plan for Alzheimer's disease patients by evaluating the therapeutic efficacy and side effect of various evidence-based programs.  Methods  Alzheimer's disease, donepezil, rivastigmine, galantamine, memantine, rosiglitazone, etc. were defined as retrieval words. PubMed, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure (CNKI) databases were used with applying of manual searching. Systematic reviews, randomized controlled trials (RCT), controlled clinical trials and case-observation studies were collected and evaluated by Jadad Scale. Results  After screening, 33 selected resources included 14 systematic reviews, 14 randomized controlled trials, 4 controlled clinical trials and 1 case-observation study. According to Jadad Scale, total 28 articles were evaluated to be high quality (12 with score 4, 10 score 5, 6 score 7), and 5 were low quality with score 3. It was summarized as follows: 1) Alzheimer's disease is a progressive neurodegenerative disease for which no cure exists. To date, only symptomatic treatments with cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and an N-methyl-D-aspartate (NMDA) receptor noncompetitive antagonist (memantine), are effective and well tolerated to counterbalance the neurotransmitter disturbance, but cannot limit or impact on disease progression. 2) Disease modifying drug is an potential agent, with persistent effect on slowing the progression of structural damage, and can be detected even after withdrawing the treatment. Many types of disease modifying drugs are undergoing clinical trials.  Conclusions  Using evidence-based medicine methods can provide best clinical evidence on Alzheimer's disease treatment.

Key words: Alzheimer disease, Drug therapy, Evidence-based medicine