Objective: To assess the safety of olanzapine, risperidone and quetiapine drugs in dementia patients with behavioral and psychological symptoms. Methods: The EMBASE, Cochrane Controlled Trials Register and the Cochrane Database of Systematic Reviews, Medline, CNKI, Wang Fang were systematically searched for eligible randomized controlled trials of olanzapine, risperidone and quetiapine drugs therapy in patients with psychotic symptoms of dementia before February 2016. Two reviewers independently assessed the quality of the trials and extracted information. All the data was analyzed with meta analysis and software of the Revman5.3 provided by Cochrane network. Results: Overall, 16 relevant RCTs with 1 727 participants were identified (olanzapine group: 672; quetiapine group: 395; risperidone group: 660). (1)Olanzapine group had higher incidence of somnolence than risperidone group (OR=1.49, 95% CI [-1.01-2.21], P=0.05), while for the dizziness, agitation, accidental injury, weight gain, abnormal gait, weakness, sleep disorders, extrapyramidal symptoms, there were no significant difference. (2) Risperidone had higher incidence of extrapyramidal symptoms than quetiapine group (OR=0.11, 95% CI [0.04-0.27], P=0.64), the incidence of somnolence was lower than quetiapine group (OR=0.03, 95% CI [1.06-3.51], P=0.03), while for accidental injury, dizziness, fatigue, insomnia, constipation, there were no significant difference. (3) Olanzapine group had higher incidence of extrapyramidal symptoms than quetiapine group (OR=11.10, 95% CI [3.35-36.75], P<0.000 1), while for somnolence, sleep disturbances, constipation, agitation, weight gain, dizziness, there was no significant difference. (4) The subgroup analysis showed that in the Chinese population, compared with the population in Europe and America, risperidone group had higher incidence of agitation, sleep disorders than olanzapine (agitation: [OR= 0.26, 95% CI [0.08-0.82]; sleep disorders: OR= 0.31, 95% CI [0.10-0.99]), olanzapine group had higher incidence of weight gain than quetiapine (OR=6.8, 95% CI [2.00-23.14]). Conclusions: Among olanzapine, risperidone and quetiapine, risperidone has lowest incidence of somnolence, quetiapine has lowest incidence of extrapyramidal symptoms. In the Chinese population, compared with the population in Europe and America, risperidone group has higher incidence of agitation, sleep disorders than olanzapine, and olanzapine group has higher incidence of weight gain than quetiapine.
目的： 系统评价非典型抗精神病药奥氮平、利培酮、喹硫平治疗痴呆患者精神行为症状的疗效和安全性。 方法： 系统检索EMBASE、the Cochrane Library、Medline、万方数字知识服务平台、中国知网(CNKI)，截至2016年2月为止的有关非典型抗精神病药奥氮平、利培酮、喹硫平治疗痴呆精神行为症状的随机、双盲、非安慰剂对照试验。对文献进行质量评价后，应用RevMan5.3软件进行数据处理。 结果： 本系统评价共纳入16个随机对照试验，包括1 727例患者(奥氮平组672例，喹硫平组395例，利培酮组660例)。结果显示：(1)奥氮平组嗜睡发生率高于利培酮组[OR＝1.49，95% CI (－1.01～2.21)，P＝0.05]，在头晕、激越、意外受伤、体质量增长、步态异常、乏力、睡眠障碍、锥体外系症状等不良反应方面，两组间差异无统计学意义。(2)利培酮组锥体外系症状发生率高于喹硫平组[OR＝0.11，95% CI (0.04～0.27)，P＝0.64]，嗜睡发生率低于喹硫平组[OR＝0.03，95% CI (1.06～3.51)，P＝0.03]，在意外受伤、头晕、疲乏、失眠、便秘等不良反应方面，两组间差异无统计学意义。(3)奥氮平组锥体外系症状发生率高于喹硫平组[OR＝11.10，95% CI (3.35～36.75)，P<0.000 1]，在嗜睡、睡眠障碍、便秘、激越、体质量增长、头晕等不良反应方面，两组间差异无统计学意义。(4)中国人群与欧美人群间的亚组分析结果提示，在中国人群中利培酮组在激越、睡眠障碍方面的发生率高于奥氮平组[OR＝0.26，95% CI (0.08～0.82)；OR＝0.31，95% CI (0.10～0.99)]，奥氮平组在体质量增长方面，其发生率高于喹硫平组[OR＝6.8，95% CI (2.00～23.14)]。 结论： 在奥氮平、利培酮、喹硫平三者中，利培酮嗜睡症状发生率最低，喹硫平锥体外系症状发生率最低。中国人群与欧美人群相比，利培酮激越、睡眠障碍发生率高于奥氮平，奥氮平体重增长发生率高于喹硫平。.
Keywords: Antipsychotic agents; Dementia; Meta-analysis.