血管内皮生长因子受体酪氨酸激酶抑制剂致非小细胞肺癌患者高血压风险Meta分析  

Risk of hypertension associated with vascular endothelial growth factor receptor tyrosine kinase inhibitors in patients with non-small cell lung cancer： a Meta-analysis

作　　者：魏安华 丁玉峰 彭金兰[2] 

机构地区：[1]华中科技大学同济医学院附属同济医院药学部,武汉430030 [2]华中科技大学同济医学院附属普爱医院内分泌科,武汉430030

出　　处：《药物不良反应杂志》2018年第1期30-37,共8页Adverse Drug Reactions Journal

摘　　要：目的系统评价血管内皮生长因子受体酪氨酸激酶抑制剂（VEGFR-TKI）治疗非小细胞肺癌（NSCLC）致高血压和严重高血压的风险。方法检索国内外有关数据库截至2017年8月收录的VEGFR-TKI治疗NSCLC致高血压的RCT，以应用VEGFR-TKI的患者为试验组，以应用安慰剂和/或试验组除外VEGFR-TKI的药物的患者为对照组，结局指标为高血压和严重高血压发生率。采用Jadad评分量表评价纳入文献质量，采用STATA 13.1软件进行Meta分析，结果用RR及其95%CI表示。结果纳入分析的文献共18篇，13篇为高质量，5篇为低质量；涉及患者10 020例，试验组5 274例，对照组4 746例。Meta分析结果显示，试验组高血压和严重高血压发生率均明显高于对照组［15.8%（834/5 274）比3.8%（179/4 746），RR=4.11，95%CI：3.50～4.81，P＜0.001；3.49%（184/5 274） 比0.70%（33/4 746），RR=4.64，95%CI：3.22～6.68，P=0.000］。亚组分析显示，凡德他尼组高血压、严重高血压发生率均明显高于对照组［15.1%（397/2 625）比2.3%（49/ 2 136），RR=5.99，95%CI：4.45～8.07，P＜0.001；3.4%（90/2 625）比0.6%（13/2 163），RR=4.97，95%CI：2.79～8.85，P＜0.001］、索拉非尼组高血压、严重高血压发生率均明显高于对照组［15.7%（201/1 278）比5.4%（68/1 249），RR=2.90，95%CI：2.22～3.79，P＜0.001；4.0%（52/1 278）比1.0%（12/1 249），RR=4.09，95%CI：2.21～7.55，P＜0.001］；西地尼布组高血压、严重高血压发生率均高于对照组［ 32.1%（89/277）比8.7%（24/276），RR=3.70，95%CI：2.43～5.62，P＜0.001；12.2%（34/277）比1.8%（5/276），RR=6.77，95%CI：2.68～17.08，P＜0.001］；莫替沙尼组高血压发生率明显高于对照组，［26.1%（139/533）比6.5%（35/539），RR=4.02，95%CI：2.83～5.70，P＜0.001］。结论NSCLC患者应用VEGFR-TKI可增加发生高血压和严重高血压的风险。ObjectiveTo systematically evaluate the risk of hypertension and serious hypertension due to vascular endothelial growth factor receptor tyrosine kinase inhibitors （VEGFR-TKIs） in patients with non-small cell lung cancer （NSCLC）.MethodsThe related databases were searched for the randomized controlled trials （RCTs） on the hypertension induced by VEGFR-TKI before August 2017. The patients with NSCLC who were treated with VEGFR-TKIs were enrolled into the test group, the patients who received placebo and/or the patients in the test group who used the other drugs except VEGFR-TKI were enrolled into the control group. The outcomes of all RCTs were the incidence of hypertension and serious hypertension. The quality of the enrolled literature was evaluated by Jadad scoring system. The Meta-analysis was conducted by STATA 13.1 software. The results were expressed as relative risk （RR） and 95% confidence interval （CI）.ResultsA total of 18 RCTs involving 10 020 patient were enrolled, including 5 274 in the test group and 4 746 in the control group. The result of literature′s quality evaluation showed 13 of high grade and 5 of low grade. The results of the Meta-analysis showed that the incidence of a hypertension and serious hypertension in test group were significantly higher than those in the control group, respectively [15.8% （834/5 274） vs. 3.8% （179/4 746）, RR=4.11, 95%CI： 3.50-4.81, P〈0.001; 3.49% （184/5 274） vs. 0.70% （33/4 746）, RR=4.64, 95%CI： 3.22-6.68, P〈0.001]. The results of the subgroup analysis showed that the incidences of hypertension and serious hypertension in the vandetanib group were significantly higher than those in the control group[15.1% （397/2 625） vs. 2.3% （49/2 136）, RR=3.72, 95%CI： 2.80-4.95, P〈0.001; 3.4% （90/2 625） vs. 0.6% （13/2 163）, RR=5.99, 95%CI： 4.45-8.07,P〈0.001]; the incidences of hypertension and serious hypertension in the sorafenib group were significantly higher than those in the control group[15.7% （201/1 278�

关 键 词：血管内皮生长因子类 癌 非小细胞肺 高血压 META-分析 

分 类 号：R544.1[医药卫生—心血管疾病] R734.2[医药卫生—内科学]