5-HT3受体拮抗剂预防高度化疗所致急性恶心呕吐的网状Meta分析  

Network Meta-analysis of 5-HT3 Receptor Antagonists for Prevention of Acute Nausea and Vomiting Caused by High-dose Chemotherapy

作　　者：张田 李超[1] 倪倩[1] 裴艺芳[1] 任佚[1] 胡欣[1] ZHANG Tian;LI Chao;NI Qian;PEI Yi-fang;REN Yi;HU Xin(Department of Pharmacy, Assessment of Clinical Drugs Risk and Individual Application Key Laboratory, National Center of Gerontology, Beijing Hospital, Beijing 100730, China)

机构地区：[1]北京医院药学部药物临床风险与个体化应用评价北京市重点实验室国家老年医学中心

出　　处：《中国药学杂志》2019年第14期1194-1202,共9页Chinese Pharmaceutical Journal

摘　　要：目的使用Network Meta分析系统评价5-羟色胺3(5-HT3)受体拮抗剂预防高度化疗所致急性恶心呕吐的疗效。方法制定检索策略,系统检索Pubmed、EMbase、Cochrane Library、中文科技期刊全文数据库(VIP)、万方和中国期刊全文数据库(CNKI)等电子数据库(截止2018年10月),筛选5-HT3受体拮抗剂单药治疗预防成人高度化疗所致恶心呕吐的随机对照实验(randomized controlled trial,RCT),对符合条件的RCT进行质量评价和资料提取,结局指标包括急性恶心和呕吐。应用STATA13. 0软件和WINBUG软件,采用传统Meta分析和Network Meta分析方法对纳入的RCT研究结果进行合并。结果共纳入20项研究,共计接受高度致吐性化疗患者4 042例,包含7种干预措施(格拉司琼、昂丹司琼、帕洛诺司琼、雷莫司琼、托烷司琼、多拉司琼和阿扎司琼),研究总臂数为41。传统Meta分析结果显示,与昂丹司琼相比,帕洛诺司琼预防高度化疗所致急性恶心和呕吐疗效较好,差异有统计学意义(P <0. 05);对于高度化疗所致急性呕吐,帕洛诺司琼疗效优于格拉司琼,差异有统计学意义(P <0. 05);雷莫司琼疗效可能优于格拉司琼(OR=0. 639),但差异无统计学意义(P> 0. 05);昂丹司琼疗效可能劣于格拉司琼(OR=1. 238),但差异无统计学意义(P>0. 05);对于高度化疗所致急性恶心,昂丹司琼疗效可能劣于格拉司琼(OR=1. 232),但差异无统计学意义(P>0. 05);雷莫司琼疗效可能优于格拉司琼(OR=0. 632),但差异无统计学意义(P>0. 05)。Network Meta分析发现,对于高度化疗所致急性呕吐,昂丹司琼疗效劣于帕洛诺司琼(OR=0. 60,95%CI:0. 39~0. 88);帕洛诺司琼疗效优于雷莫司琼(OR=2. 54,95%CI:1. 16~5. 80)。SUCRA结果显示,预防高度化疗所致急性恶心疗效最佳的是帕洛诺司琼,之后依次为雷莫司琼、多拉司琼、昂丹司琼、格拉司琼和托烷司琼。预防高度化疗所致急性呕吐疗效最佳的是帕洛诺司琼,之后依�OBJECTIVE To evaluate the efficacy of 5-HT3 antagonists in the prevention of acute nausea and vomiting caused by high-dose chemotherapy using the network Meta-analysis system. METHODS Developing retrieval strategies,system retrieves electronic databases such as Pubmed,EMbase,Cochrane Library,VIP,Wanfang and CNKI( as of October 2018),to find a randomized controlled trial( RCT) that uses 5-HT3 receptor antagonist alone to prevent nausea and vomiting caused by high-dose chemotherapy in adults. Quality assessment and data extraction were performed on eligible RCTs,with outcomes including acute nausea and vomiting.The results of the included RCT studies were combined using traditional STA analysis and network Meta-analysis using STATA13. 0 software and WINBUG software. The results of the included RCT studies were combined using traditional Meta-analysis and network Meta-analysis. RESULTS A total of 20 studies were included,involving a total of 4 042 patients with high-dose emetogenic chemotherapy. Seven interventions were included( granstron,ondansetron,ramosetron,tropisetron,dolasetron,azasetron,and palonosetron) with a total arm count of 41. The traditional Meta results showed that palonosetron was more effective in preventing acute nausea and vomiting caused by high-dose chemotherapy than ondansetron,and the difference was statistically significant( P < 0. 05). For acute vomiting caused by high-dose chemotherapy,palonosetron was superior to granisetron,and the difference was statistically significant( P < 0. 05). The efficacy of ramosetron may be better than granisetron( OR = 0. 639),but the difference was not statistically significant( P >0. 05). Ondansetron may be inferior to granisetron( OR = 1. 238),but the difference is not statistically significant( P > 0. 05). For acute nausea caused by high-dose chemotherapy,ondansetron may be inferior to granisetron( OR = 1. 232),but the difference was not statistically significant( P > 0. 05). Ramosetron may be better than granisetron( OR = 0. 632),but the difference was

关 键 词：5-HT3受体拮抗剂 高度化疗 恶心 呕吐 网状Meta分析 

分 类 号：R969.3[医药卫生—药理学]