重组人血小板生成素及白介素-11应用于白血病化疗所致血小板减少症的系统评价

Meta-analysis of recombinant human thromobopoietin and recombinant human interleukin-11 in the treatment of chemotherapy induced thrombocytopenia

目的评价重组人血小板生成素（rh TPO）及重组人白细胞介素-11（rh IL-11）应用于白血病化疗后血小板减少症的有效性与安全性。方法采用循证医学的方法,计算机检索中国知网（1997-2015年1月）、万方数据资源系统（1977-2015年1月）、中国科技期刊数据库（1989-2015年1月）,收集rh TPO和rh IL-11治疗白血病化疗后血小板减少症的所有平行对照试验。结果共纳入7篇文献。与rh IL-11组相比,rh TPO能增加白血病患者恢复血小板的最高值,缩短白血病患者化疗后血小板≤50×10^9/L的持续时间,缩短白血病患者化疗后恢复至血小板≥75×10^9/L的时间（均P〈0.00001）;rh TPO组不良反应发生率更低[RR 0.19,95%CI（0.12-0.31）,P〈0.00001]。但rh TPO组和rh IL-11组患者化疗后血小板的最低值及rh TPO组和rh IL-11组恢复至血小板≥100×10^9/L的时间无明显差异。结论在治疗白血病化疗后血小板减少症方面,与rh IL-11组相比,rh TPO能够增加血小板恢复的最高值、缩短血小板≤50×10^9/L的持续时间和恢复至血小板≥75×10^9/L的时间,并减少不良反应的发生。但二者对改善化疗后血小板的最低值和使患者恢复至血小板≥100×10^9/L的时间方面差异无统计学意义。然而,目前的临床试验设计存在不足,需要设计完善的大样本随机对照试验进行验证。

Objective To assess the effectiveness and the safety of recombinant human thromobopoietin（rhTPO） and recombinant human interleukin-11 （rhIL-11 ） in the treatment of chemotherapy induced thromboeytopenia. Methods Computer retrieval was conducted to search for randomized controlled studies in which rhTPO was compared with rhIL-11 in chemotherapy induced thrombocytopenia in CNKI（ 1997 to January,2015） ,WANFANG DATA（ 1977 to January,2015） ,and CSTJ（ 1989 to January,2015）. The results were analyzed by using RevMan5.2.4 software according to the methods of evidence based medicine. Results A total of 7 literatures were included. Compared with rhIL-11, rhTPO could further increase the maximum value of blood platelet, shorten the time interval of blood platelet less than 50×10^9/L and the time for blood platelet elevating above 75 ×10^9/L（ all P 〈 0. 00001 ）. In addition, the incidence of adverse drug reactions was low in rhTPO group（RR=0. 19,95% CI =0. 12 - 0. 31 ,P 〈 0. 00001 ）. However,there was no significant difference in the improvement of minimum value of blood platelet after chemotherapy and in the duration of platelet recovery ≥ 100×10^9/L between the two drugs. Conclusion The rhTPO can improve maximum platelet count recovery, shorten the duration of platelet count ≤50×10^9/L, speed up platelet recovery ≥〉 75×10^9/L and indirectly reduce ADR in the treatment of chemotherapy induced thrombocytopenia when compared with rhIL-11. However, large-scale trials with perfect design are needed to confirm the results since there are insufficient designs in all the current clinical trials.