NK-1受体抑制剂联合地塞米松与5-HT_3受体抑制剂预防和治疗以卡铂为基础的化疗导致的恶心呕吐的疗效与安全性的Meta分析  

Efficacy and Safety of NK-1 Receptor Inhibitor Combined with Dexamethasone and 5-HT_3 Receptor Inhibitor for the Prevention and Treatment of Carboplatin-based Chemotherapy-induced Nausea and Vomiting:A Meta-analysis

作　　者：刘中飞 陈永钧 李芹 王秀玲 黄易 LIU Zhongfei;CHEN Yongjun;LI Qin;WANG Xiuling;HUANG Yi(Dept.of Pharmacy,the Affiliated Hospital of Southwest Medical University,Sichuan Luzhou 646000,China;Dept.of Pharmacy,Children＇s Hospital of Chongqing Medical University,Chongqing 400014,China)

机构地区：[1]西南医科大学附属医院药学部,四川泸州646000 [2]重庆医科大学附属儿童医院药学部,重庆400014

出　　处：《中国药房》2018年第23期3269-3274,共6页China Pharmacy

基　　金：四川省科技创新苗子工程资助项目(No.2018104)

摘　　要：目的:系统评价神经激肽1(NK-1)受体抑制剂联合地塞米松与5-羟色胺3(5-HT3)受体抑制剂对比地塞米松联合5-HT3受体抑制剂预防和治疗以卡铂为基础的化疗导致的恶心呕吐的疗效与安全性,为临床提供循证参考。方法:计算机检索PubMed、CENTRAL、Embase、中国期刊全文数据库,检索时限为自建库起到2018年1月,收集NK-1受体抑制剂联合地塞米松、5-HT3受体抑制剂(试验组)对比地塞米松联合5-HT3受体抑制剂(对照组)预防和治疗以卡铂为基础的化疗导致的恶心呕吐的随机对照试验(RCT),对符合标准的文献进行资料提取并按照Cochrane系统评价员手册5.1.0进行质量评价后,采用Rev Man 5.3统计学软件对急性期、延迟期呕吐完全缓解(CR)率,急性期、延迟期恶心完全控制率、不良反应(便秘、疲劳、厌食、腹泻)发生率进行Meta分析。结果:共纳入9项RCT,合计1 676例患者。Meta分析结果显示,试验组患者急性期呕吐CR率[OR=2.63,95%CI(1.29,5.37),P=0.008]、延迟期呕吐CR率[OR=2.10,95%CI(1.69,2.62),P<0.001]、延迟期恶心完全控制率[OR=1.77,95%CI(1.14,2.77),P=0.01]显著高于对照组,差异均有统计学意义;两组患者急性期恶心完全控制率比较,差异无统计学意义[OR=1.27,95%CI(0.92,1.76),P=0.15];两组患者便秘、疲劳、厌食、腹泻等不良反应发生率比较,差异均无统计学意义(P>0.05)。结论 :现有证据证明NK-1受体抑制剂联合地塞米松与5-HT3受体抑制剂预防和治疗以卡铂为基础的化疗导致的恶心呕吐,在提高急性期、延迟期呕吐CR率和延迟期恶心完全控制率上优于地塞米松联合5-HT3受体抑制剂,且未增加便秘、疲劳、厌食、腹泻等不良反应的发生。OBJECTIVE：To evaluate the efficacy and safety of neurokinin-1 （NK-1） receptor inhibitor combined with dexamethasone and 5-hydroxytryptamine 3（5-HT3）receptor inhibitor versus dexamethasone combined with 5-HT3 receptor inhibitor for the prevention and treatment of carboplatin-based chemotherapy-induced nausea and vomiting,and to provide evidence-based reference in clinic. METHODS：Retrieved from PubMed,CENTRAL,Embase and CJFD during database establishment to Jan. 2018,randomized controlled trial （RCTs） about NK-1 receptor inhibitor combined with dexamethasone and 5-HT3 receptor inhibitor （trial group） versus dexamethasone combined with 5-HT3 receptor inhibitor （control group） for carboplatin-based chemotherapy-induced nausea and vomiting were collected. After data extraction and quality evaluation according to Cochrane system evaluator manual 5.1.0,Meta-analysis was performed for complete remission rate （CR） of acute and delayed vomiting,complete control rate of acute and delayed nausea,the incidence of ADR（constipation,fatigue,anorexia,diarrhea）by using Rev Man 5.3 statistical software. RESULTS：Totally 9 RCTs were included,involving 1 676 patients. Results of Meta-analysis showed that CR rate of acute vomiting [OR=2.63,95%CI（1.29,5.37）,P=0.008] and delayed vomiting [OR=2.10,95%CI（1.69,2.62）,P〈0.001],complete control rate of delayed nausea [OR=1.77,95% CI（1.14,2.77）,P=0.01] in trial group were significantly higher than control group,with statistical significance. There was no statistical significance in complete control rate of acute nausea between 2 groups [OR=1.27,95%CI（0.92,1.76）,P=0.15]. There was no statistical significance in the incidence of constipation, fatigue,anorexia,diarrhea between 2 groups（P〉0.05）. CONCLUSIONS：Current evidence shows that NK-1 receptor inhibitor combined with dexamethasone and 5-HT3 receptor inhibitor can prevent and treat nausea and vomiting induced by carboplatin-based chemotherapy, and is better than dexamethasone combined

关 键 词：神经激肽1受体抑制剂 卡铂 化疗 恶心呕吐 疗效 安全性 META分析 

分 类 号：R975.4[医药卫生—药品]