硼替佐米联合不同化疗药物治疗多发性骨髓瘤疗效和安全性的Meta分析

目的:评价硼替佐米联合不同化疗药物治疗多发性骨髓瘤的疗效与安全性。方法:计算机检索PubMed数据库，Cochrane图书馆临床对照试验数据库，中国期刊全文数据库和中国生物医学文献数据库，进一步对纳入文献的参考文献进行扩大搜索。采用RevMan 5.3软件进行Meta分析。结果:共纳入8篇文献，包括1 627例患者。Meta分析显示硼替佐米联合地塞米松和沙利度胺(BTD)组较硼替佐米联合地塞米松(BD)组缓解率好［OR=1.70，95%CI（1.18，2.44），P=0.005］，感染率［OR=1.19，95%CI（0.73，1.94），P=0.48］和3-4级血小板减少率［OR=2.17，95%CI（0.91，5.19），P=0.08］无统计学差异。硼替佐米联合地塞米松和阿霉素（BAD）组较BD组缓解率高［OR=3.79，95%CI（1.28，11.22），P=0.01］。BTD组和硼替佐米联合马法兰和泼尼松（BMP）组缓解率无统计学差异［OR=1.42，95%CI（0.96，2.09），P=0.08］。3-4级不良事件发生率无统计学差异［OR=1.55，95%CI（0.61，3.90），P=0.35］。BAD组和硼替佐米联合地塞米松和环磷酰胺（BCD）组缓解率无统计学差异［OR=0.99，95%CI（0.61，1.59），P=0.96］，BCD组疗效好于BAD组。结论:硼替佐米三药联合较硼替佐米二药联合效果好，毒副反应基本相同。不同的三药联合方案效果也不同，在BTD、BAD、BCD、BMP这几个方案中，BCD效果最好。

Effectiveness and safety of bortezomib combined with different chemotherapeutics for trea-ting multiple myeloma:A Meta -analysis

Objective:To assess the effectiveness and safety of bortezomib combined with different chemotherapeu-tics for treating multiple myeloma.Methods:Data were searched from PubMed,Cochrane central Register of Con-trolled Trials(CENTRAL)of The Cochrane Library China National Knowledge Infrastructure(CNKI)and China Biol-ogy Medicine(CBM).Data analysis was performed with RevMan 5.3.Results:A total of 8 articles involving 1 627 pa-tients were included.Meta -analysis results showed BTD was better than BD about OROR =1.80,95%CI(1.25, 2.61),P =0.002],and the infection rateOR =1.19,95%CI(0.73,1.94),P =0.48]and 3 and 4 grade thrombo-cytopeniaOR =2.17,95%CI(0.91,5.19),P =0.08]had no significant differences.BAD was better than BD about OROR =3.79,95%CI(1.28,11.22),P =0.01].BTD and BMP had no significant differences about OR OR =1.42,95%CI(0.96,2.09),P =0.08]and 3 and 4 grade adverse events had no significant differencesOR =1.55, 95%CI(0.61,3.90),P =0.35].BCD and BAD had no significant differences about OROR =0.99,95%CI(0.61, 1.59),P =0.96],but BCD has better effect than BAD.Conclusion:Bortezomib plus two drugs is better than borte-zomib plus one drugs and the side effect had no significant differences.The different plan about bortezomib plus two drugs have different effect,BCD is the best about BTD,BAD,BCD,BMP.