氟尿嘧啶类药物相关心脏缺血并发症发生率的Meta分析  

Incidence of Cardiac Ischemic Complications Associated with Fluoropyrimidines:a Meta-analysis

作　　者：石兆昆 来毓博 鲁亚杰 Shi Zhaokun;Lai Yubo;Lu Yajie(Basic Medical School,Air Force Medical University of PLA,Xi'an 710032;Department of Clinical Oncology,The First Affiliated Hospital of Air Force Medical University of PLA)

机构地区：[1]中国人民解放军空军军医大学基础医学院,西安710032 [2]中国人民解放军空军军医大学第一附属医院肿瘤科

出　　处：《药物流行病学杂志》2022年第11期725-737,共13页Chinese Journal of Pharmacoepidemiology

摘　　要：目的:系统评价氟尿嘧啶类药物导致心脏缺血并发症的发生率概况,并进一步探索不同肿瘤和不同治疗方案对发生率的影响。方法:计算机检索PubMed、EMbase、Medline、Web of Science、The Cochrane Library、ClinicalTrials.gov数据库,搜集关于氟尿嘧啶类药物相关心脏缺血并发症的前瞻性或回顾性临床研究文献,检索时限均为从建库至2021年3月。由两名研究者独立筛选文献、提取资料并评价纳入研究的质量后,采用R软件对氟尿嘧啶类药物相关心脏缺血并发症的发生率进行Meta合并、亚组分析和Meta回归分析。采用敏感性分析和Egger检验评估Meta分析结果的稳定性和发表偏倚。结果:共纳入文献125篇,包括47398例患者。Meta分析结果显示,氟尿嘧啶类药物相关心脏缺血并发症的总体发生率为2.24%[95%CI(1.65%,2.93%)],3级及以上并发症不良事件发生率为1.30%[95%CI(0.88%,1.80%)]。亚组分析结果显示,(1)不同肿瘤类型的患者氟尿嘧啶类药物相关心脏缺血的发生率存在差异,乳腺癌患者发生率最低(0.21%),而食管癌患者发生率最高(4.68%);(2)治疗方案与心脏缺血发生密切相关,合并治疗的发生率高于单药治疗(P<0.01),卡培他滨相关心脏缺血的发生率低于氟尿嘧啶(P<0.01)。敏感性分析和Egger检验证实本Meta分析结果具有较高的稳定性和可靠性。结论:氟尿嘧啶类药物相关心脏缺血并发症发生率较低,且不同肿瘤类型和治疗方案间存在差异。受纳入研究间各种潜在异质性因素的影响,上述结论尚需进一步开展更多大样本研究进行验证。Objective:To systematically review the incidence of fluoropyrimidine-related cardiac ischemic complications,and to further explore the differences in the incidence among different tumors and different drug regimens.Methods:PubMed,EMbase,Medline,Web of Science,The Cochrane Library and ClinicalTrials.gov databases were searched to collect prospective or retrospective clinical studies on fluoropyrimidine-related cardiac ischemic complications from inception to March 2021.Two reviewers independently screened literature,extracted data and quality of included studies.Then,meta-analysis,subgroup analysis,and meta-regression analysis of the incidence of cardiac ischemic complications were conducted using R software.Sensitivity analysis and Egger’s test were used to assess the stability and publication bias of the meta-analysis results.Results:A total of 125 literatures involving 47398 patients were included.The results of meta-analysis showed that the pooled overall incidence of fluorouracil-related cardiac ischemic complications was 2.24%(95%CI 1.65%to 2.93%),and the pooled incidence of grade 3 or higher complications was 1.30%(95%CI 0.88%to 1.80%).Subgroup analysis showed that:(1)the incidence of cardiac ischemia differed among different tumor types,with the lowest incidence of breast cancer(0.21%)and the highest incidence of esophageal cancer(4.68%);(2)fluoropyrimidine-related cardiac ischemia was closely related to treatment regimens.The incidence of combined therapy was higher than that of monotherapy(P<0.01),and the incidence of cardiac ischemia associated with capecitabine was lower than that of 5-fluorouracil(P<0.01).Sensitivity analysis and Egger’s test confirmed the stability and reliability of the meta-analysis results.Conclusion:The incidence of fluoropyrimidine-related cardiac ischemia complications is relatively low and varies between tumor types and treatment regimens.Due to the influence caused by various potential heterogeneity factors of included studies,more large size studies are needed to verify

关 键 词：氟尿嘧啶类药物 心脏缺血 肿瘤治疗 META分析 

分 类 号：R979.11[医药卫生—药品]