5-HT3受体拮抗剂联合地塞米松预防化疗所致恶心呕吐的临床疗效

Analysis of curative effect of 5-HT3 receptor antagonist combined with Dexamethasone in preventing chemotherapy-induced nausea and vomiting

目的探讨第一代5-羟色胺3受体拮抗剂(5-HT3RA)托烷司琼(Tropisetron,TRO)与第二代5-HT3RA帕洛诺司琼(Palonosetron,PAL)联合地塞米松预防化疗所致恶心和呕吐的疗效及安全性。方法选择2015年1月至2018年12月在广西医科大学附属肿瘤医院诊治,并接受含有高度催吐风险方案进行多日化疗的192例肿瘤患者为研究对象。采用随机、交叉自身对照法分为PAL组和TRO组,其中PAL组止吐方案为帕洛诺司琼联合地塞米松,TRO组为托烷司琼联合地塞米松方案。比较两组患者恶心、呕吐发生率及止吐药物相关不良反应发生率。结果 PAL组和TRO组患者在急性期(d1)的恶心和呕吐发生率差异均无统计学意义(均P>0.05),PAL组在延迟期(d2~5)及全程(d1~5)的恶心发生率均低于TRO组(均P<0.05),在延迟期(d3~d4)及全程呕吐的发生率亦低于TRO组(均P<0.05)。TRO组有57.3%的患者需重复使用5-HT3RA,高于PAL组的39.3%(P<0.05)。与止吐药物相关或可能相关的不良反应包括便秘、腹胀、头痛和呃逆等,两组不良反应发生率差异无统计学意义(P>0.05)。结论第二代5-HT3RA帕洛诺司琼防治延迟性化疗所致恶心和呕吐的疗效优于第一代5-HT3RA托烷司琼,安全性良好。

Objective To investigate the efficacy and safety of the first-generation 5-HT3 receptor antagonist(5-HT3RA)Tropisetron(TRO)and the second-generation 5-HT3RA Palonosetron(PAL),respectively,combined with Dexamethasone(DXM)in the prevention of chemotherapy-induced nausea and vomiting. Methods A total of 192 patients with cancer,treated in the Guangxi Medical University Cancer Hospital from January 2015 to December 2018 through highly emetogenic chemotherapy,were investigated and selected into the PAL group and TRO group by a randomized self-crossover method. Among them,the antiemetic scheme of the PAL group was the PAL+DXM,and the TRO group was the TRO+DXM. The incidence of nausea,vomiting and antemetic adverse reactions were compared between the two groups. Results There was no significant difference in the incidence rate of nausea and vomiting between the PAL group and TRO group(all P>0.05)during acute phase(d1). In the delayed phase(d2-d5)and whole phase(d1-d5),the nausea rate in the PAL group were markedly lower than that in the TRO group(all P<0.05). In the delayed phase(d3-d4)and whole phase,vomiting rate in the PAL group were also lower than that in the TRO group(all P<0.05). 57.3% of patients in the TRO group had to use 5-HT3RA repeatedly,which was significantly higher than 39.3% in the PAL group(P<0.05). The adverse reactions of antiemetic drugs included constipation,abdominal distension,headache,and hiccups,while the incidence of adverse reactions was similar between the two groups(P >0.05).Conclusions The second-generation of 5-HT3RA PAL is better than the first-generation of 5-HT3RA TRO in the prevention of delayed chemotherapy-induced nausea and vomiting.