PEG-rhG-CSF与rhG-CSF降低乳腺癌患者化疗所致中性粒细胞减少的系统评价和Meta分析

Systematic Review and Meta-analysis of PEG-rhG-CSF and rhG-CSF in Reducing Chemotherapy-induced Neutropenia in Breast Cancer Patients

目的:比较聚乙二醇化重组人粒细胞刺激因子(PEG-rhG-CSF)和重组人粒细胞刺激因子(rhG-CSF)降低乳腺癌患者化疗后中性粒细胞减少的临床疗效和安全性,为临床用药提供循证依据。方法:计算机检索CNKI、万方数据库、CBMdisc、维普数据库、Cochrane Library、PubMed和EMBase有关PEG-rhG-CSF与rhG-CSF预防乳腺癌患者化疗后中性粒细胞减少的随机对照试验(RCT),数据分析采用RevMan 5.4.1软件。结果:经筛选得到11项研究,Meta分析显示:PEG-rhG-CSF与rhG-CSF在化疗后第1周期FN发生率、多个化疗周期总FN发生率、化疗后第1周期Ⅳ度中性粒细胞减少的持续时间、中性粒细胞减少恢复时间、抗生素使用率、骨痛或骨骼肌肉痛的发生率、3~4级不良反应的发生率比较,差异无统计学意义(P>0.05);而PEG-rhG-CSF可以更有效降低化疗后第1周期Ⅲ/Ⅳ度中性粒细胞减少的发生率(P<0.05)。结论:PEG-rhGCSF较rhG-CSF能有效降低乳腺癌患者化疗后第1周期Ⅲ/Ⅳ度中性粒细胞减少的发生率,推荐PEG-rhG-CSF一级预防化疗后中性粒细胞减少。

Objective:To compared the clinical efficacy and safety of pegylated recombinant human granulocyte colony-stimulating factor(PEG-rhG-CSF)and recombinant human granulocyte colony-stimulating factor(rhG-CSF)in reducing neutropenia in breast cancer patients after chemotherapy,Provide evidence-based basis for clinical medication.Methods:Randomized controlled trials(RCT)focusing on the Prevention of neutropenia of PEG-rhG-CSF and rhG-CSF in breast cancer patients after chemotherapy were searched in databases including CNKI,Wanfang database,CBMdisc,VIP,Cochrane Library,PubMed and EMBase.Meta-analysis of the included study data was performed using RevMan 5.4.1 software.Results:11 studies were screened.Meta-analysis results showed PEG-rhG-CSF and rhG-CSF in the incidence rate of FN for cycle one,the incidence rate of FN for all cycle,the duration of grade IV neutropenia for cycle one,the time to absolute neutrophil count recovery,the utilization rate of antibiotics,the incidence of bone pain or musculoskeletal pain,and the incidence of grade 3-4 adverse reactions were no significant difference(P>0.05).PEG-rhG-CSF was more effective in reducing the incidence of grade III/IV neutropenia for cycle one after chemotherapy(P<0.05).Conclusion:Compared with rhG-CSF,PEG-rhG-CSF could effectively reduce the incidence of grade III/IV neutropenia in breast cancer patients in cycle one after chemotherapy.PEG-rhG-CSF was recommended for primary prevention of neutropenia after chemotherapy.