皮下注射与静脉注射硼替佐米治疗多发性骨髓瘤的疗效与不良事件的Meta分析

Meta-analysis of efficacies and adverse events of subcutaneous injection and intravenous injection of bortezomib inthetreatmentofmultilemeloma

目的:系统评价硼替佐米皮下注射与静脉注射治疗多发性骨髓瘤的临床疗效与安全性,为临床工作提供参考。方法:计算机检索Pubmed、Embase、OVID、Cochrane图书馆、中国期刊全文数据库(CNKI)、万方数据库、维普数据库,并进一步对纳入文献的参考文献扩大检索。对纳入的随机对照研究采用Cochrane风险偏倚评估工具进行质量评估,采用RevMan5.3软件进行统计学分析。结果:本研究纳入了5篇文献,共990例患者,Meta分析结果显示皮下注射组与静脉注射组的缓解率差异无统计学意义[66.9%(337/504)∶71.6%(292/408),OR=0.97,95%CI0.72~1.32,P=0.87]。常见的不良反应中,血小板减少症在皮下注射组与静脉注射组间差异无统计学意义[15.5%(78/504)∶15.4%(63/408),OR=0.78,95%CI 0.52~1.18,P=0.24],而皮下注射组周围神经病变的发生率低于静脉注射组[15.1%(83/549)∶26.1%(115/441),OR=0.39,95%CI 0.28~0.55,P<0.01]。结论:硼替佐米皮下注射与静脉注射治疗多发性骨髓瘤的缓解率无明显差异,但可以降低周围神经病变的发生率。

Objective：To evaluate the efficiencies and safety of subcutaneous injection and intravenous injection of bortezomib in the treatment of multiple myeloma.Method：The database were reviewed,including Cochrane Library,OVID,Embase,Pubmed,China National Knowledge Infrastructure（CNKI）,WanFang database and VIP databases.Besides,references of the articles were further to searched.The quality of randomized controlled trails was assessed by the Cochrane collaboration＇s risk tool.Meta-analysis used RevMan 5.3 software for statistical analysis.Result：A total of 5 articles involved 990 patients with multiple myeloma were included.Meta-analysis showed that the rate of remission had no difference between the subcutaneous injection group and the intravenous injection group[66.9%（337/504）vs.71.6%（292/408）,OR=0.97,95%CI 0.72-1.32,P=0.87].There was no difference in the incidence of thrombocytopenia between the subcutaneous injection group and the intravenous injection group[15.5%（78/504）vs.15.4%（63/408）,OR=0.78,95%CI 0.52-1.18,P=0.24],but the incidence of peripheral neuropathy in the subcutaneous injection group was lower than that in the intravenous injection group[15.1%（83/549）vs.26.1%（115/441）,OR=0.39,95%CI0.28-0.55,P〈0.01].Conclusion：The rate of remission has no difference between the subcutaneous injection group and the intravenous injection group,but the incidence of peripheral neuropathy in the subcutaneous injection group is lower than that in the intravenous injection group.