恶性肿瘤患者甲氨蝶呤血药浓度监测与安全性Meta分析

Meta-Analysis on Blood Concentration Monitoring on Methotrexate and Its Safety for Malignant Tumor Patients

目的评价甲氨蝶呤血药浓度监测对恶性肿瘤治疗安全性的影响。方法检索Pub Med,Cochrane Library,EMBase,Ovid Technologies,中国知网(CNKI),维普(VIP),万方7个电子数据库的随机对照试验(RCTs)和观察性试验,按纳入和排除标准筛选出合格的文献,并对其进行Meta分析,检索时限从建库至2016年10月;纳入罹患恶性肿瘤、使用甲氨蝶呤治疗并进行血药浓度质量评价的病例,其中共包含287例患者、2种肿瘤类型;结果用Revman 5.3软件进行统计与分析。结果共纳入3篇RCTs和1篇观察性研究;与未做血药浓度监测的恶性肿瘤患者相比,血药浓度监测组患者不良反应,包括胃肠道不良反应、口腔溃疡、肝功能异常、四肢不适、皮肤黏膜损害发生情况显著减少(P<0.05),而骨髓抑制发生率较高。结论对使用甲氨蝶呤的恶性肿瘤患者进行血药浓度监测,可有效减少不良反应的发生。

Objective To evaluate the safety of blood concentration monitoring on methotrexate for malignant tumor patients.Methods Randomized controlled trials(RCTs)and observational studies were searched from PubMed,Cochrane Library,EMBase,Ovid Technologies,CNKI,VIP and Wanfang data.According to the inclusion exclusion criteria,the qualified literatures were selected and the Meta analysis was performed.The retrieval time was from the of establishment of databases to the October 2016.The patients with malignant tumor treated with methotrexate and performed quality evaluation of blood concentration were included,including 287 patients and 2 tumor types,the Revman 5.3 software was used to carry out statistics and analysis for the results.Results Three RCTs and one observational study were included.Compared with the tumor patients who did not do blood concentration monitoring,the adverse reactions included adverse reactions in gastrointestinal tract,oral ulcer,abnormal liver function,limb discomfort,skin and mucosa damage in the blood concentration monitoring group were significantly reduced(P<0.05),but the incidence rate of myelosuppression was high.Conclusion Blood concentration monitoring for malignant tumor patients treated with methotrexate can effectively reduce the incidence of adverse reactions.