Clinical Medication Analysis Of Alzheimer’s Disease And Systematic Review Of Ginkgo Biloba Preparations And Citrus Flavanone Active Ingredients Drug Therapy

Objective: Prescription analysis is used to evaluate the current medication situation of AD patients in our hospital,summarize the main contents of pharmacy services for patients,and systematically evaluate the therapeutic effects of ginkgo biloba preparations and citrus flavanone active ingredients on Alzheimer’s disease(AD).Methods: 1.Clinical medication analysis: Search the websites and databases,select and analyze the guideline.Use the hospital prescription review system to randomly extract the outpatient prescriptions from January 2018 to December 2019 in our hospital and select the clinical diagnosis for AD.Each prescription information was entered using Excel 2010,and the descriptive research method was used to count the prescription medication situation and evaluate its rationality according to the instructions and guidelines.2.Meta-analysis of ginkgo biloba preparations: A comprehensive literature search was conducted on Pub Med,Web of Science,Embase,CBM,CNKI,VIP and Wan Fang databases from inception to October 29,2019.According to the inclusion and exclusion criteria,two evaluators independently screened the literature for quality evaluation.Rev Man 5.3.5 software was used for statistical analysis.3.Systematic review of citrus flavanone active ingredients: A comprehensive search of the literature on the role of citrus flavanones in rodent AD models in the databases Pub Med,Embase and Web of Science,a systematic review of the effects of citrus flavanones on AD model animals,and the effects of citrus flavanones on oxidative stress markers were meta-analyzed.Results: 1.Clinical medication analysis: A total of 9 AD-related clinical guidelines and 264 outpatient prescriptions were collected.Among them,51.52% of the prescriptions are combined medications,and the two-drug combination is the most common.29.17% of the included prescriptions are unreasonable prescriptions.The main reasons are improper usage and dosage,inappropriate drug selection,repeated medication and interaction with certain drugs.2.Meta-analysis of ginkgo biloba preparations: A total of 21 randomized controlled trials were included in this study.(1)Compared with citicoline,ginkgo biloba preparations can improve MMSE[MD =3.80,95%CI(2.05,5.55),P < 0.0001],ADL scores[MD =-3.30,95%CI(-4.75,-1.85),P < 0.00001] and total effective rate[OR = 3.69,95%CI(1.87,7.27),P = 0.0002] more effectively;(2)Compared with the use of only basic treatment or other drugs alone,the combination of ginkgo biloba preparations can improve MMSE[MD = 2.68,95%CI(2.35,3.02),P < 0.00001],ADL score[MD =-3.48,95%CI(-4.36,-2.60),P <0.00001] and total effective rate[OR = 3.50,95%CI(1.09,11.22),P =0.03] more effectively;(3)Compared with placebo or no intervention,ginkgo biloba preparations can effectively improve MMSE[MD =1.82,95%CI(0.33,3.32),P=0.02] and ADL scores[MD =-7.00,95%CI(-10.93,-3.07),P =0.0005];(4)Compared with donepezil monotherapy,the combination of donepezil and ginkgo biloba preparations can improve MMSE[MD =1.82,95%CI(0.33,3.32),P =0.02],ADL scores[MD =-4.29,95%CI(-5.58,-2.99),P<0.00001] and total effective rate[OR =2.95,95%CI(1.42,6.13),P=0.004] more effectively;(5)The treatment of ginkgo biloba preparations has a significantly lower effect on the MMSE score[MD =-1.79,95%CI(-2.39,-1.20),P<0.00001] and total effective rate[OR=0.15,95%CI(0.08,0.30),P<0.00001] than donepezil.3.Systematic review of citrus flavanone active ingredients: A total of 14 literatures were included.Studies have shown that compared with the control group,citrus flavanone significantly inhibits changes in oxidative stress markers and increased nitrite content in different brain regions of AD animal models,and significantly inhibits the activity of acetylcholinesterase(ACh E).Conclusions: 1.Clinical medication analysis: The selection of anti-AD drugs in our hospital is mostly consistent with the recommendations in the guidelines,but there are certain irrationalities.Drugs should be selected carefully in clinical treatment and reasonable pharmaceutical services should be performed to effectively reduce the risk of medication for patients.2.Meta-analysis of ginkgo biloba preparations: Ginkgo biloba preparations are effective in the treatment of AD,and there is no significant difference in adverse reactions.3.Systematic review of citrus flavanone active ingredients: Citrus flavanone has protective effects on cognitive dysfunction and oxidative damage in AD animal models.