疏血通注射液临床安全性的系统分析

Systematic analysis on clinical safety of Shuxuetong injection

目的:全面了解疏血通注射液的不良反应(adverse drug reaction,ADR)发生情况和相关因素,为疏血通注射液临床合理应用和上市后的再评价提供参考。方法:通过计算机检索国内外医学期刊数据库,根据纳入排除标准选取文献,并提取资料,按不同类别分别计算疏血通注射液ADR发生数,根据有对照的临床研究中可获得的用药人数与ADR病例数估算ADR发生率。结果:共纳入88篇涉及疏血通注射液不良反应报告的文献,其中临床研究65篇,个案报告20篇,不良反应监测或分析报告3篇;共计报告不良反应174例;疏血通注射液不良反应涉及的系统或器官主要集中在循环系统、神经系统、消化系统、皮肤及其附属器;不良反应类型主要以皮疹(44.3%)以及消化系统反应(23.0%)为主;65篇有对照组的临床研究文献分析显示不良反应发生率为4.3%。结论:疏血通注射液不良反应以过敏反应为主;多个研究疏血通ADR的发生率差别大,有必要进行严格设计的前瞻性ADR监测重新评估疏血通的ADR发生率、分析不同研究间异质性的可能原因;文献中安全性的信息缺失严重,报告质量不高,建议在临床试验中加强主动、规范、系统的不良反应报告。

Objective： To evaluate the clinical adverse drug reactions （ADR） of Shuxuetong Injection （SXTI） comprehensively for its proper use and post-marketing reevaluation. Method ： Electronic searching of the online Chinese and English medical databases were carried out from their inception to Feb. 2012, studies were screened and data were extracted according to inclusion and exclusion criteria; total number of ADR were calculated by study type respectively, ADR incidence rate was calculated by number of ADRs in experimental arm of clinical trials with control groups divided by total number of experimental groups. Result： Eighty and eight papers published concerning ADRs report of SXTI were included, including 65 clinical trials, 20 case reports, and 3 ADRs surveillance or analysis report. 174 ADRs were reported, mainly in circulation system, nervous system, the digestive system, skin and appendages. Adverse reaction type is mainly rash （44. 3% ） and the digestive system response （23.0%）. The incidence rate calculated by data extracted from 65 clinical trials was 4. 3%. Conclusion： Allergic reaction is the most common ADR type of SXTI. Incidence rate of different studies varies, so a rigorously designed prospectively ADR surveillance study is needed to reevaluate its incidence rate, and analyze reasons of the heterogeneity. Information concerning ADR in literatures is always absent, the quality of reporting is relative poor, thus it is suggested that active, standardized, and systematic ADR reporting should be focused on in clinical trials.