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目的:系统评价阿瑞匹坦联合5-羟色胺3(5-HT3)受体拮抗药和地塞米松三联疗法对恶性肿瘤化疗患者安全性及生活质量的影响,为临床提供循证参考。方法:计算机检索Cochrane图书馆、PubMed、Embase、万方、维普、中国知网、中国生物医学文献数据库等,收集阿瑞匹坦三联疗法(试验组)vs.5-HT3受体拮抗药联合地塞米松(对照组)预防化疗相关性恶心呕吐的随机对照试验(RCT)和队列研究,提取资料并对文献进行质量评价[RCT类文献根据Cochrane系统评价员手册5.3进行质量评价;非RCT类文献采用纽卡斯尔-渥太华量表进行质量评价]后,采用Rev Man 5.3软件进行Meta分析。结果:共纳入21篇文献,合计7 698例患者。Meta分析结果显示,试验组患者的疲乏[OR=0.80,95%CI(0.67,0.95),P=0.01]、呃逆[OR=0.52,95%CI(0.34,0.82),P=0.004]、便秘[OR=0.73,95%CI(0.63,0.85),P<0.001]、其他药物相关性不良反应[OR=0.79,95%CI(0.66,0.95),P=0.01]的发生率均显著低于对照组,差异均有统计学意义;其恶心呕吐功能性生活指数的相关Meta分析结果显示,试验组患者的日常生活质量显著高于对照组 [OR=1.60,95%CI(1.41,1.83),P<0.001;MD=10.64,95%CI(8.10,13.18),P<0.001],差异有统计学意义。结论:阿瑞匹坦联合5-HT3受体拮抗药和地塞米松的三联疗法能显著减少恶性肿瘤化疗中疲乏、呃逆、便秘、其他药物相关性不良反应的发生,改善患者生活质量,提高其治疗依从性。
OBJECTIVE: To systematically review the effects of triple therapy of aprepitant combined with 5-HT3 receptor antagonist and dexamethasone on the safety and daily life quality of malignant cancer chemotherapy patients, and to provide evidence-based reference in clinic. METHODS: Studies were identified by searching Cochrane Library, PubMed, Embase, WanFang Database, VIP Database, CNKI and CBM, including randomized controlled trials and cohort studies of triple therapy of aprepitant(trial group) vs. 5-HT3 receptor antagonist combined with dexamethasone(control group) for the prevention of chemotherapy-induced nausea and vomiting. After data extraction, quality evaluation of literature was conducted (RCT literature quality evaluation according to Cochrane systematic evaluator manual 5.3, non-RCT literatures with Newcastle-Ottawa Scale), Meta-analysis was conducted by using Rev Man 5.3.0 software. RESULTS: Totally 21 literatures were included, involving 7 698 patients. The results of Meta-analysis showed that the incidence of fatigue [OR=0.80, 95%CI(0.67,0.95),P=0.01], hiccup [OR=0.52,95%CI(0.34,0.82),P=0.004], constipation [OR=0.73,95%CI(0.63,0.85),P<0.001], other drug-related ADR [OR=0.79,95%CI(0.66,0.95),P=0.01] in trial group were significantly lower than control group, with statistical significance. The results of Meta-analysis of functional life index of nausea and vomiting showed that the quality of daily life in trial group was significantly higher than control group [OR=1.60,95%CI(1.41,1.83), P<0.001; MD=10.64,95%CI(8.10,13.18),P<0.001], with statistical significance. CONCLUSIONS: Triple therapy of aprepitant combined with 5-HT3 receptor antagonist and dexamethasone can significantly reduce the occurrence of fatigue, hiccup, constipation and other drug-related ADR during malignant cancer chemotherapy, improve life quality and treatment compliance of patients.
阿瑞匹坦三联疗法恶性肿瘤不良反应恶心呕吐功能性生活指数Meta分析
AprepitantTriple therapyMalignant cancerADRFunctional life index of nausea and vomitingMeta-analysis
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