谷胱甘肽预防奥沙利铂致周围神经毒性疗效的系统评价  

Systematic Evaluation of the Efficacy of Glutathione in Preventing Oxaliplatin-induced Peripheral Neurotoxicity

作　　者：魏晓晨[1] 赵菁[2] 朱立勤[1] 王春革[1] 邓琦[1] 李新[1] 

机构地区：[1]天津市第一中心医院,天津300192 [2]天津市红桥医院,天津300130

出　　处：《中国药房》2017年第9期1216-1220,共5页China Pharmacy

基　　金：天津市卫生局科技基金项目(No.2014KY09)

摘　　要：目的:系统评价谷胱甘肽(GSH)预防奥沙利铂致周围神经毒性(OIPN)的疗效与安全性,为临床提供循证参考。方法:全面检索Pub Med、EMBase、Cochrane图书馆、中国期刊全文数据库、万方数据库和中文科技期刊数据库中收录的GSH对比安慰剂/无任何措施(统称安慰剂组)或其他药物预防OIPN疗效的随机对照试验(RCT)。提取资料并用改良的Jadad量表进行质量评价后,采用Rev Man 5.3统计软件进行Meta分析。结果:共纳入18项RCT,合计1 200例患者。Meta分析结果显示,GSH组患者奥沙利铂致慢性周围神经毒性(OICPN)总发生率[RR=0.71,95%CI(0.59,0.87),P<0.001]、严重OICPN发生率[RR=0.50,95%CI(0.42,0.60),P<0.001]显著低于安慰剂组,差异均有统计学意义,但两组患者奥沙利铂致急性周围神经毒性(OIAPN)发生率比较差异无统计学意义[RR=0.89,95%CI(0.72,1.09),P=0.25];GSH组患者严重OICPN发生率显著高于甲钴胺组,差异有统计学意义[RR=2.06,95%CI(1.07,3.99),P=0.03];GSH组与钙镁合剂组患者OICPN总发生率[RR=1.38,95%CI(0.83,2.31),P=0.21]与严重OICPN发生率[RR=1.91,95%CI(0.85,4.30),P=0.12]比较差异均无统计学意义。结论:GSH可以有效预防OICPN的发生,预防效果与钙镁合剂相当,但在预防严重OICPN方面疗效劣于甲钴胺。OBJECTIVE：To systematically evaluate the efficacy and safety of glutathione（GSH） in preventing oxaliplatin-induced peripheral neurotoxicity（OIPN）,and to provide evidence-based reference in the clinic. METHODS：Randomized controlled trials（RCTs） about therapeutic efficacy of GSH vs. placebo/no any measures（called placbo group） or other drug in preventing OIPN were retrieved from Pub Med,EMBase,Cochrane library,CJFD,Wanfang database and VIP. Meta-analysis was performed with Rev Man 5.3 statistical software after data extraction and quality evaluation with Jadad scale. RESULTS：18 RCTs were included,involving 1 200 patients. The results of Meta-analysis showed that：total incidence of oxaliplatin-induced chronic peripheral neurotoxicity（OICPN）[RR=0.71,95% CI（0.59,0.87）,P〈0.001] and the incidence of severe OICPN [RR=0.50,95% CI（0.42,0.60）,P〈0.001] in GSH group were significantly lower than placebo group,with statistical significance;there was statistical significance in the incidence of oxaliplatin-induced acute peripheral neurotoxicity（OIAPN）[RR=0.89,95%CI（0.72,1.09）,P=0.25]. The incidence of severe OICPN in GSH group was significantly higher than mecobalamine group,with statistical significance [RR=2.06,95%CI（1.07,3.99）,P=0.03]. There was no statistical significance in the incidence of OICPN[RR=1.38,95%CI（0.83,2.31）,P=0.21] and severe OICPN [RR=1.91,95%CI（0.85,4.30）,P=0.12] between GSH group and Ca＋Mg mixture group. CONCLUSIONS：GSH can effectively prevent the occurrence of OICPN,however,its therapeutic efficacy is equivalent to Ca＋Mg mixture and inferior to mecobalamine in preventing severe OICPN.

关 键 词：谷胱甘肽 奥沙利铂 预防 周围神经毒性 系统评价 

分 类 号：R73[医药卫生—肿瘤] R96[医药卫生—临床医学]