5种干预措施预防奥沙利铂致慢性神经毒性疗效的网状Meta分析  

Efficacy of 5 Kinds of Interventions in the Prevention of Chronic Neurotoxicity Induced by Oxaliplatin:a Network Meta-analysis

作　　者：郭子寒 焦园园[1,2] 范丽萍[1,2,3] 张艳华[1,2] 

机构地区：[1]北京大学肿瘤医院 [2]北京市肿瘤防治研究所药剂科/恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [3]北京大学医学部临床药学与药事管理系,北京100191

出　　处：《中国药房》2015年第24期3374-3377,共4页China Pharmacy

摘　　要：目的:系统评价甲钴胺、神经节苷酯、钙镁合剂、还原型谷胱甘肽、钙镁合剂联合还原型谷胱甘肽预防奥沙利铂致慢性神经毒性的疗效,以为临床治疗提供循证参考。方法:计算机检索Pub Med、clinicltrials.gov和中国期刊全文数据库,收集比较上述5种干预措施预防奥沙利铂致慢性神经毒性的随机对照试验(RCT),提取资料并进行质量评价后,采用ADDIS 1.16.5统计软件进行网状Meta分析。结果:共纳入34项研究,合计3 236例患者。其中,4项为三臂研究,30项为双臂研究,研究总臂数为42。5种措施与安慰剂相比均显著降低了化疗致周围神经病变的发生率,疗效排第一位的为钙镁合剂+还原型谷胱甘肽,其余的依次为甲钴胺、还原型谷胱甘肽、神经节苷酯、钙镁合剂,但这5种措施两两之间比较差异无统计学意义(P>0.05)。结论:5种干预措施预防奥沙利铂致慢性神经毒性均有效,钙镁合剂联合还原型谷胱甘肽的效果最好。受纳入研究方法学质量限制,该结论有待大样本、高质量的RCT进一步验证。OBJECTIVE： To systematically evaluate the efficacy of mecobalamin, ganglioside, mixture of calcium and magnesium, reduced glutathione, mixture of calcium and magnesium combined with reduced glutathione in the prevention of chronic neurotoxicity induced by oxaliplatin, and to provide evidence-based reference for clinic treatment. METHODS： Retrieved from PubMed, clinicltrials.gov and CJFD, randomized controlled trials （RCT） about efficacy of 5 interventions in the prevention of chronic neurotoxicity induced by oxaliplatin were collected, and network Meta-analysis were performed by using ADDIS 1.16.5 after extracting data and evaluating quality. RESULTS： A total of 34 studies were included, involving 3 236 patients. 4 studies were three-arm studies, 30 studies were two-arm studies, totally 42 arms. Compared with placebo, the incidence of CIPN by 5 interventions was significantly reduced. Mixture of calcium and magnesium combined with reduced glutathione was the most effective and the followed by mecobalamin, reduced glutathione, ganglioside and mixture of calcium and magnesium, however, there were no significant differences among 5 interventions（P〉0.05）. CONCLUSIONS： 5 kinds of interventions are all effective in the prevention of chronic neurotoxicity induced by oxaliplatin. Mixture of calcium and magnesium combined with reduced glutathione is the most effective. Duo to the low quality of included studies, large-scale and high quality RCTs are required for further validation of the conclusions.

关 键 词：网状Meta分析 预防 奥沙利铂 慢性神经毒性 疗效 系统评价 

分 类 号：R737.9[医药卫生—肿瘤] R979.19[医药卫生—临床医学]