维生素类药物预防化疗致周围神经毒性的疗效及安全性的Meta分析

Meta-analysis of the Efficacy and Safety of Vitamins in Preventing Chemotherapy-induced Peripheral Neuropathy in Cancer Patients

关键词:  维生素类药物  化疗  预防  周围神经毒性  Meta分析

Key words:  vitamins  chemotherapy  prevention  peripheral neuropathy  meta-analysis

摘要:

目的 系统评价维生素类药物预防化疗致周围神经毒性(peripheral neuropathy，PNP)的疗效及安全性。方法 全面检索PubMed、EMbase、Cochrane Libraries、CNKI、万方和维普数据库中收录的维生素类药物预防化疗致PNP的随机对照试验(RCT)，检索时限均从建库至2015年8月。在资料提取和质量评价后，采用RevMan5.3软件进行meta分析。结果 共纳入14个RCT，包括889例患者。Meta分析结果显示：①维生素E组与对照组在预防顺铂致PNP总发生率[RR=0.34，95%CI(0.18，0.66)，P=0.001]、严重PNP发生率[RR=0.25，95%CI(0.08，0.77)，P=0.02]及PNP评分[SMD=-0.79，95%CI(-1.20，-0.37)，p=0.000 2]方面均有统计学差异；在预防紫杉醇致PNP总发生率[RR=0.30，95%CI(0.10，0.89)，P=0.03]及PNP评分[SMD=-0.95，95%CI(-1.69，-0.21)，P=0.01]方面有统计学差异，而在严重PNP发生率方面无统计学差异；在预防奥沙利铂致PNP总发生率及严重PNP发生率方面均无统计学差异；②甲钴胺组与对照组在预防化疗致PNP总发生率[RR=0.44，95%CI(0.36，0.55)，P<0.000 01]、严重PNP发生率[RR=0.28，95%CI(0.18，0.43)，P<0.000 01]及PNP评分[SMD=-0.64，95%CI(-1.00，-0.27)，P=0.000 7]方面均有统计学差异。纳入所有研究均未发现与维生素E或甲钴胺相关的不良反应发生。结论 在预防顺铂致PNP时应选维生素E；在预防奥沙利铂或长春新碱致PNP时应选甲钴胺；在预防紫杉醇致PNP时优选甲钴胺，次选维生素E。

Abstract:

OBJECTIVE To assess the efficacy and safety of vitamins in preventing chemotherapy-induced peripheral neuropathy(PNP) in cancer patients. METHODS Studies were identified by searching PubMed, EMbase, Cochrane Libraries, CNKI, WanFang and WeiPu Database from the date of establishment until August 2015. Randomized controlled trials(RCTs) that evaluated the efficacy of vitamins in preventing chemotherapy-induced PNP in cancer patients were included. Statistical analysis was performed with RevMan5.3. RESULTS Fourteen RCTs involving 889 patients were included. The results of meta-analyses were as follows: ①There were statistically significant differences between vitamin E group and control group in all incidence of PNP [RR=0.34, 95%CI(0.18, 0.66), P=0.001], incidence of severe PNP [RR=0.25, 95%CI(0.08, 0.77), P=0.02] and PNP score [SMD=-0.79, 95%CI(-1.20, -0.37), P=0.000 2] by cisplatin; There were statistically significant differences between vitamin E group and control group in all incidence of PNP [RR=0. 30, 95%CI(0.10, 0.89), P=0.03] and PNP score [SMD=-0.95, 95%CI(-1.69, -0.21), P=0.01] by paclitaxel, while no statistically significant differences in incidence of severe PNP; There were no statistically significant differences between vitamin E group and control group in all incidence of PNP and incidence of severe PNP by oxaliplatin. ②There were statistically significant differences between mecobalamine group and control group in all incidence of PNP [RR=0.44, 95%CI(0.36, 0.55), P<0.000 01], incidence of severe PNP [RR=0.28, 95%CI(0.18, 0.43), P<0.000 01] and PNP score [SMD=-0.64, 95%CI(-1.00, -0.27), P=0.000 7]. All studies included found no adverse reactions induced by vitamin E or mecobalamine. CONCLUSION In order to prevent PNP by cisplatin, vitamin E should be chosen. In order to prevent PNP by oxaliplatin or vincristine, mecobalamine should be chosen. Mecobalamine should be the better choice than vitamin E in preventing PNP by paclitaxel.