右丙亚胺预防乳腺癌患者蒽环类药物化疗所致心脏毒性有效性的Meta分析  

Effectiveness of Dexrazoxane in the Prevention of Cardiac Toxicity Caused by Chemotherapy of Anthracyclines in Patients with Breast Cancer:a Meta-analysis

作　　者：郑丽[1] 顾玲琪 袁年平 沈倩影 刘锐 刘露露 张琳[1] ZHENG Li;GU Lingqi;YUAN Nianping;SHEN Qianying;LIU Rui;LIU Lulu;ZHANG Lin(Department of Pharmacy,Maternal and Child Health Care Center Affiliated to Nantong University,Nantong 226018,China)

机构地区：[1]南通大学附属妇幼保健院药事科

出　　处：《实用心脑肺血管病杂志》2019年第12期1-5,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：江苏省重点研发计划(社会发展)项目(BE2015655)

摘　　要：目的评价右丙亚胺(DZR)预防乳腺癌患者蒽环类药物化疗所致心脏毒性的有效性。方法计算机检索中国知网、万方数据知识服务平台、中国生物医学文献数据库、PubMed、Cochrane Controlled Register of Trials及EMBase等数据库,检索时间从建库至2019年5月,筛选DZR预防乳腺癌患者蒽环类药物所致心脏毒性有效性的临床随机对照试验(RCTs)。对照组患者采用以蒽环类药物为基础的化疗方案,干预组患者在对照组治疗基础上预防性使用DZR。采用RevMan 5.3软件进行Meta分析;比较两组患者临床心脏毒性发生率、亚临床心脏毒性发生率,化疗后心肌肌钙蛋白T(c TnT)、脑钠肽(BNP)、肌酸激酶同工酶(CK-MB)水平及左心室射血分数(LVEF),无进展生存期(PFS)、总生存期(OS)、完全应答率(CR)及部分应答率(PR)。结果 (1)最终纳入10篇文献,共包括1 672例患者。(2)Meta分析结果显示,干预组患者临床心脏毒性发生率[RR=0.17,95%CI(0.09,0.32)]、亚临床心脏毒性发生率[RR=0.33,95%CI(0.26,0.43)]及化疗后c TnT[MD=-18.27,95%CI(-22.52,-14.03)]、BNP[MD=-70.14,95%CI(-94.51,-45.76)]、CK-MB[MD=-7.92,95%CI(-12.31,-3.53)]水平低于对照组,化疗后LVEF[MD=0.11,95%CI(0.05,0.16)]高于对照组(P<0.05)。两组患者PFS[HR=0.97,95%CI(0.73,1.29)]、OS[HR=1.04,95%CI(0.88,1.23)]、CR[RR=1.04,95%CI(0.68,1.57)]及PR[RR=0.88,95%CI(0.74,1.05)]比较,差异无统计学意义(P>0.05)。结论现有文献证据表明,DZR可有效减轻乳腺癌患者蒽环类药物化疗所致心脏毒性,且不会影响蒽环类药物化疗效果。Objective To evaluate the effectiveness of dexrazoxane(DZR)in the prevention of cardiac toxicity caused by chemotherapy of anthracyclines in patients with breast cancer. Methods Computer was used to search databases(such as CNKI,Wanfang Data,CBM,PubMed,Cochrane Controlled Register of Trials and EMBase)to screen RCTs about effectiveness of DZR in the prevention of cardiac toxicity caused by chemotherapy of anthracyclines in patients with breast cancer from creating databases to May 2019. Patients in control group were treated by chemotherapy based on anthracyclines,while patients in intervention group preventively used DZR based on that of control group. RevMan 5.3.0 software was used to carry out the Meta-analysis,incidence of clinical cardiac toxicity and subclinical cardiac toxicity,cTnT,BNP,CK-MB and LVEF after chemotherapy,as well as progression-free survival(PFS),overall survival(OS),complete response rate(CR)and partial response rate(PR)were compared between the two groups. Results(1)A total of 10 literatures were enrolled,including 1,672 patients.(2)Meta-analysis results showed that,intervention group showed statistically significantly lower incidence of clinical cardiac toxicity[RR=0.17,95%CI(0.09,0.32)]and subclinical cardiac toxicity[RR=0.33,95%CI(0.26,0.43)]compared with those in control group,as well as statistically significantly lower cTnT[MD=-18.27,95%CI(-22.52,-14.03)],BNP[MD=-70.14,95%CI(-94.51,-45.76)]and CK-MB[MD=-7.92,95%CI(-12.31,-3.53)]after chemotherapy,but showed statistically significantly higher LVEF after chemotherapy[MD=0.11,95%CI(0.05,0.16)](P<0.05);however,there was no statistically significant difference in PFS[HR=0.97,95%CI(0.73,1.29)],OS[HR=1.04,95%CI(0.88,1.23)],CR[RR=1.04,95%CI(0.68,1.57)]or PR[RR=0.88,95%CI(0.74,1.05)]between the two groups(P>0.05). Conclusion Available literature evidence shows that,DZR can effectively relieve the cardiac toxicity caused by chemotherapy of anthracyclines in patients with breast cancer,without obvious influence on the chemotherapeutic efficacy

关 键 词：乳腺癌 右丙亚胺 蒽环类 心脏毒性 化疗效果 META分析 

分 类 号：R737.9[医药卫生—肿瘤]