根据一项涵盖逾1.3亿人健康数据的新研究分析，抗生素、抗病毒药物、疫苗和抗炎药物与降低痴呆症风险相关。

Antibiotics, antivirals, vaccinations and anti-inflammatory medication are associated with reduced risk of dementia, according to new research that looked at health data from over 130 million individuals.

该研究由剑桥大学和埃克塞特大学的研究人员牵头，团队目前已找到一些已获批并投入使用的药物有可能被转用于治疗痴呆症。

The study, led by researchers from the universities of Cambridge and Exeter, identified several drugs already licensed and in use that have the potential to be repurposed to treat dementia.

在英国，痴呆症是造成人口死亡的主要原因之一，也会给患者本人及其照护者带来极大的痛苦。据估计，痴呆症的全球经济成本已超过1万亿美元。

Dementia is a leading cause of death in the UK and can lead to profound distress in the individual and among those caring for them. It has been estimated to have a worldwide economic cost in excess of US$1 trillion dollars.

尽管付出了巨大的努力，但在寻找能够减缓或预防痴呆症的药物方面进展仍然有限。截至目前为止，痴呆症药物仅能缓解痴呆症状，且疗效有限。近年来，科学家们已证实来卡奈单抗（lecanemab）和多奈单抗（donanemab）能够减少淀粉样蛋白斑块在大脑中的的积聚（这是阿尔茨海默病的关键特征），并减缓病情发展。然而，英国国家健康与护理卓越研究所（NICE）给出结论是上述两种药物对于治疗痴呆症的裨益不大，因而未批准在英国国家医疗服务体系（NHS）内使用这两种药物。

Despite intensive efforts, progress in identifying drugs that can slow or even prevent dementia has been disappointing. Until recently, dementia drugs were effective only for symptoms and have a modest effect. Recently, lecanemab and donanemab have been shown to reduce the build-up in the brain of amyloid plaques – a key characteristic of Alzheimer’s disease – and to slow down progression of the disease, but the National Institute for Health and Care Excellence (NICE) concluded that the benefits were insufficient to justify approval for use within the NHS.

来自剑桥大学精神病学系及剑桥郡与彼得伯勒NHS信托基金会的本·安德伍德博士表示：“我们迫切需要新的治疗方法来减缓痴呆症的进展，如果不是预防的话。如果我们能在已获批用于治疗其他疾病的药物上找到解决方案，就可以直接投入临床试验。最重要的一点是，我们说不定能让患者更快地用上这些药物，这远比我们研发出一种全新药物来得快得多。而且，这些药物已经上市，所以可以降低成本，从而更可能被批准在NHS中使用。”

Dr Ben Underwood, from the Department of Psychiatry at the University of Cambridge and Cambridgeshire and Peterborough NHS Foundation Trust, said: “We urgently need new treatments to slow the progress of dementia, if not to prevent it. If we can find drugs that are already licensed for other conditions, then we can get them into trials and – crucially – may be able to make them available to patients much, much faster than we could do for an entirely new drug. The fact they are already available is likely to reduce cost and therefore make them more likely to be approved for use in the NHS.”

在今日发表在《阿尔茨海默症与痴呆症：转化研究与临床干预》期刊的一项研究中，安德伍德博士与埃克塞特大学的伊利安娜·劳里达（Ilianna Lourida）博士一起对现有科学文献进行了一个系统性综述，以寻找会影响痴呆症风险的处方药的证据。系统性回顾可以帮助研究人员汇总多个研究，即使研究中的证据可能较弱，甚至相互矛盾，也可以得出更有力的结论。

In a study published today in Alzheimer’s and Dementia: Translational Research & Clinical Interventions, Dr Underwood, together with Dr Ilianna Lourida from the University of Exeter, led a systematic review of existing scientific literature to look for evidence of prescription drugs that altered the risk of dementia. Systematic reviews allow researchers to pool several studies where evidence may be weak, or even contradictory, to arrive at more robust conclusions.

研究团队一共分析了14项基于大型临床数据集和医疗记录的研究，数据涵盖超过1.3亿个体和100万例痴呆症病例。虽然不同研究在确定影响痴呆症风险的单个药物方面缺乏一致性，但研究团队仍然找到了一些与痴呆症风险变化相关的药物类别。

In total, the team examined 14 studies that used large clinical datasets and medical records, capturing data from more than 130 million individuals and 1 million dementia cases. Although they found a lack of consistency between studies in identifying individual drugs that affect the risk of dementia, they identified several drug classes associated with altered risk.

研究团队还发现，某些类别的药物存在相互矛盾的证据。例如，一些降压药和抗抑郁药，以及一些相对来说影响程度较低的糖尿病药物，与降低痴呆症风险相关，而另一些则可能增加风险。

The team found conflicting evidence for several classes of drugs, with some blood pressure medications and anti-depressants and, to a lesser extent, diabetes medication associated with a decreased risk of dementia and others associated with increased risk.

来自英国国家健康与护理研究院（NIHR）西南半岛应用研究合作中心（PenARC）和埃克塞特大学的伊利安娜·劳里达（Ilianna Lourida）博士指出：“某种药物与痴呆症风险的变化相关，并不意味着它一定会引发或对痴呆症有效果。比如，我们知道糖尿病会增加痴呆症风险，因此使用药物来控制血糖水平的人自然面临更高的痴呆症风险——但这并不意味着药物本身会增加风险。”

Dr Ilianna Lourida from the National Institute for Health and Care Research Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, said: “Because a particular drug is associated with an altered risk of dementia, it doesn’t necessarily mean that it causes or indeed helps in dementia. We know that diabetes increases your risk of dementia, for example, so anyone on medication to manage their glucose levels would naturally also be at a higher risk of dementia – but that doesn’t mean the drug increases your risk.

“需要牢记的是，所有药物都有利有弊。患者绝不应在未和医生商量的情况下擅自更改用药。如果患者对药物有任何疑虑，应该咨询医生。”

“It’s important to remember that all drugs have benefits and risks. You should never change your medicine without discussing this first with your doctor, and you should speak to them if you have any concerns.”

相互矛盾的研究结果可能反映了不同研究的开展方式及数据收集方法的差异。同时，即使属于同一类别，不同药物的生物作用机制也可能有所不同。

The conflicting evidence may also reflect differences in how particular studies were conducted and how data was collected, as well as the fact that different medications even within the same class often target different biological mechanisms.

目前，英国政府正在支持一个阿尔茨海默病试验平台的建立，以便快速、高效地评估各类药物，包括目前用于其他疾病的再利用药物。

The UK government is supporting the development of an Alzheimer’s trial platform to evaluate drugs rapidly and efficiently, including repurposed drugs currently used for other conditions.

“整合这些大规模健康数据为我们提供了重要的研究依据，这有助于我们聚焦应该优先对哪些药物进行试验。”安德伍德博士表示，“我们希望这将意味着我们能找到亟需的新型痴呆症治疗方法，并加快惠及患者的进度。”

“Pooling these massive health data sets provides one source of evidence which we can use to help us focus on which drugs we should try first,” said Dr Underwood. “We’re hopeful this will mean we can find some much-needed new treatments for dementia and speed up the process of getting them to patients.”