Methylphenidate用於改善創傷性腦損傷病患認知功能的療效：系統性回顧與綜合分析

Effects of methylphenidate on cognitive improvement in patients with trauma brain injury: systematic review and meta-analysis

黃佳真(Chia-Chen Huang)

指導教授 ： 楊世群

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2011年)

摘要

研究背景：在臨床上，Methylphenidate被用來治療過動兒已經使用多年，且對於注意力和工作記憶等認知功能的改善效果已被證實，而methylphenidate能否同樣用於創傷性腦損傷的患者來改善其認知功能，將是本研究的目的。
研究目的：使用統合分析方法的方法，找出methylphenidate對認知功能改善的有效證據。
方法：收集1957年至2010年7月在Medline、PubMed、PscyINFO、CINAHL、EMBASE等7個電子資料庫上有關於MPH於認知功能方面改善的文獻資料。再有無正式文章發表、非隨機對照試驗設計以及病患族群是否為創傷性腦損傷為排除條件下，經過嚴謹的評讀，最後找出最具實證效力的同類文獻，使用RevMan 5之軟體計算效果量與進行綜合分析。
結果與討論：經過系統性文獻回顧，有關methylphenidate用於改善創傷性腦損傷患者其認知功能改善的研究，符合納入條件的共有9篇文獻，病人數為218位，合併各種認知功能施測工具中 (Choice Reaction Time, Gordon Diagnostic System, Ruff 2 and 7 attention test, Symbol Digit Modalities test) 的結果顯示MPH比安慰劑較具有認知功能改善的效果，其中以選擇性反應時間的表現效果較佳，而綜合的結果也顯示MPH對TBI患者的認知功能有顯著正面的效果且具顯著差異 (effect size：-0.21，95%信賴區間：-0.40 - -0.03)，各評量項目合併的結果存在著同質性的特性 (I2=0%)。但在記憶功能方面卻無顯著差異。
結論：主要的研究限制乃由於研究的樣本太少，導致證據力不足，使得找出適當的MPH治療劑量、治療療程、以及長期的治療結果還需後續更大型且長期的追蹤研究來補足。

關鍵字

創傷性腦損傷 ； methylphenidate ； 認知功能 ； 綜合分析

並列摘要

Background
The use of methylphenidate (MPH) to enhance processing speed on patients with traumatic brain injury has been viewed as an adequate pharmacotherapy. However, no sufficient and validated systematic reviews support its use in patients with brain injury to promote overall cognitive function, including attention and memory.
Methods
Searching strategy was addressed by using keywords as head injury or brain injury and methylphenidate without any limitations in the database of MEDLINE, PubMed, PsycINFO, CINAHL, EMBASE and CENTRAL from inception to Jul, 2010. Only RCTs meet the inclusion criteria. In addition hand-searching and two reviewers independently applied selection, performed quality assessment, and extracted data. Pooled data was divided into two groups, MPH group and placebo group, to determine the significance by using RevMan version 5.1.1 for data analysis. Attention, memory and cognitive function were analyzed as our outcome measures by forest plots.
Results
Nine RCTs were identified and included in this review with a total of 218 patients for planned comparison. The six RCTs of these compared the attention function (effect size: -0.21, 95% CI from -040 to -0.03) and three RCTs of these compared the memory function (effect size: -0.12, 95% CI from -0.45 to 0.22) after administrating MPH. Attention function, detected by Choice Reaction Time, Gordon Diagnostic System, Ruff 2 and 7 attention test, Symbol Digit Modalities test, meta-analysis showed were significantly enhanced in the MPH group (heterogeneity: I2=0%).
Conclusion
MPH was seems lack of evidence to improvements for attention and memory function in patients with traumatic brain injury. Well-designed researches are needed to determine the optimal dosage, duration and side effects.

並列關鍵字

traumatic brain injury ； methylphenidate ； cognitive ； meta-analysis

參考文獻

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