神经节苷脂预防化疗所致周围神经毒性疗效及安全性的系统评价

Systematic evaluation of efficacy and safety of gangliosides in preventing chemotherapy-induced peripheral neurotoxicity in cancer patients

目的评价神经节苷脂(GM1)预防化疗所致周围神经毒性(CIPN)的疗效及安全性。方法计算机检索PubMed、EMbase、Cochrane、中国生物医学文献(CBM)、中国知网(CNKI)、维普和万方数据库,从建库至2015年4月,收集GM1预防CIPN的随机对照研究用RevMan5.3软件进行Meta分析。结果共纳入9个临床研究,770例患者。GM1组与空白对照组在CIPN总发生率及严重CIPN发生率差异有统计学意义(P<0.001),而疾病控制率差异无统计学意义(P>0.05)。GM1组与钙镁合剂组在CIPN总发生率及严重CIPN发生率差异均无统计学意义(P>0.05)。GM1组与谷胱甘肽组在CIPN总发生率差异有统计学意义(P<0.01),而在严重CIPN发生率差异无统计学意义(P>0.05)。GM1组与呋喃硫胺组在CIPN总发生率及严重CIPN发生率差异有统计学意义(P<0.001)。结论 GM1能有效地预防肿瘤患者CIPN的发生,且不影响近期化疗疗效的疾病控制率,安全性较好,GM1的疗效优于谷胱甘肽及呋喃硫胺。

Objective To assess the effect and safety of ganglioside-monosialic acid（GM1） in preventing chemotherapy- induced peripheral neurotoxicity（CIPN） in cancer patients.Methods We searched PubMed,EMbase,Cochrane,CBM,CNKI,WeiPu and WanFang Database from the date of establishment until April 2015.And we collected randomized controlled study that evaluated the effects of GMl in preventing CIPN in cancer patients were selected.Statistical analysis was performed with RevMan5.3.Results Nine studies involving 770 patients were included.The results of Meta- analyses showed the following：there were statistically significant differences between GMl group and control group in all incidence of CIPN and incidence of severe CIPN（P〈0.001）,while no statistically significant differences in disease contol rates.There was no statistically significant differences between GMl group and Ca＋Mg group in all incidence of CIPN and incidence of severe CIPN（P〉0.05）.There were statistically significant differences between GMl group and glutathione（GSH） group in all incidence of CIPN（P〈0.001）,while no statistically significant differences in incidence of severe CIPN.There were statistically significant differences between GMl group and thiamine tetrahydrofurfuryl disulphiele（TTFD） group in all incidence of CIPN and incidence of severe CIPN（P〈0.001）.Conclusion GMl is an effective neuroprotective agent against CIPN and did not affect the short- term efficacy of chemotherapy and is safety.In addition,GMl has an advantage over GSH and TTFD in decreasing peripheral neurotoxicity by CIPN in cancer patients.