Day E, Bentham P, Callaghan R, Kuruvilla T, George S
Department of Psychiatry, University of Birmingham, Queen Elizabeth Psychiatric Hospital, Mindelsohn Way, Birmingham, UK, B15 2QZ.
Cochrane Database Syst Rev. 2004(1):CD004033. doi: 10.1002/14651858.CD004033.pub2.
Autopsy studies suggest that Wernicke-Korsakoff Syndrome (WKS) is not a rare disorder, particularly in individuals who abuse alcohol. Thiamine has been established as the treatment of choice for over 50 years, but there is uncertainty about appropriate dosage and duration. Current practice guidelines are based on case reports and clinical experience.
To determine the quality of evidence for the efficacy of thiamine in preventing and treating the manifestations of WKS as a consequence of alcohol excess, and if so in which form it should be given, at what dose and for how long.
Trials were identified from the latest updated search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 3 February 2003 using the terms "(thiamin* or aneurin*) and (Korsakoff* or Wernicke* or alcohol*). The CDCIG Specialized register contains up-to-date records from all major health care databases (Medline, Embase, PsycInfo, Cinahl and others) as well as from many trials databases.
All randomized trials in which treatment with thiamine or thiamine-containing products was administered and compared with alternative interventions for people with, or at risk of developing, WKS secondary to alcohol abuse.
All abstracts were independently inspected by two reviewers (ED & PB) and relevant papers were retrieved and assessed for methodological quality using Cochrane Reviewers' Handbook criteria.
Two studies were identified that met the inclusion criteria, but only one contained sufficient data for quantitative analysis. Ambrose (2001) randomized participants (n=107) to one of five doses of intramuscular thiamine and measured outcomes after 2 days of treatment. We compared the lowest dose (5mg/day) with each of the other four doses. There was a significant difference in favour of the 200mg/day compared with the 5 mg/day dose in the number of trials taken to reach criterion on a delayed alternation test (MD -17.90, 95% CI -35.4 to -0.40, p=0.04). No significant differences emerged in comparing the other doses with 5 mg/day. The pattern of results did not present a simple dose-response relationship. The study had methodological shortcomings in design and the presentation of results that limited further analysis.
REVIEWER'S CONCLUSIONS: There is insufficient evidence from randomized controlled clinical trials to guide clinicians in the dose, frequency, route or duration of thiamine treatment for prophylaxis against or treatment of WKS due to alcohol abuse.
尸检研究表明，韦尼克 - 科尔萨科夫综合征（WKS）并非罕见疾病，尤其是在酗酒者中。五十多年来，硫胺素一直是首选治疗药物，但在合适的剂量和疗程方面仍存在不确定性。当前的实践指南基于病例报告和临床经验。
确定硫胺素在预防和治疗因酒精过量导致的WKS表现方面的疗效证据质量，若有疗效，应以何种形式给药、剂量多少以及疗程多久。
通过使用术语“（硫胺素或维生素B1）和（科尔萨科夫或韦尼克或酒精*）”，从2003年2月3日对Cochrane痴呆与认知改善小组专业注册库的最新更新检索中识别试验。CDCIG专业注册库包含来自所有主要医疗保健数据库（Medline、Embase、PsycInfo、Cinahl等）以及许多试验数据库的最新记录。
所有随机试验，其中对硫胺素或含硫胺素产品进行了治疗，并与针对因酒精滥用而患有或有患WKS风险的人群的替代干预措施进行了比较。
所有摘要由两名评审员（ED和PB）独立检查，检索相关论文并根据Cochrane评审员手册标准评估方法学质量。
确定了两项符合纳入标准的研究，但只有一项包含足够的数据进行定量分析。安布罗斯（2001年）将参与者（n = 107）随机分为五剂肌肉注射硫胺素中的一组，并在治疗2天后测量结果。我们将最低剂量（5毫克/天）与其他四剂进行了比较。在延迟交替试验中达到标准所需的试验次数方面，与5毫克/天剂量相比，200毫克/天剂量有显著差异（MD -17.90，95% CI -35.4至 -0.40，p = 0.04）。将其他剂量与5毫克/天进行比较时未出现显著差异。结果模式未呈现简单的剂量 - 反应关系。该研究在设计和结果呈现方面存在方法学缺陷，限制了进一步分析。
随机对照临床试验的证据不足，无法指导临床医生确定用于预防或治疗因酒精滥用导致的WKS的硫胺素治疗的剂量、频率、途径或疗程。
