重组人血小板生成素治疗肿瘤化疗所致血小板减少症的荟萃分析

目的 比较重组人血小板生成素及重组人白细胞介素-11临床应用的疗效和安全性.方法 通过计算机检索中国生物医学文献数据库(1979年至2012年7月)、万方数据资源系统(1977年至2012年7月)、中国科技期刊数据库(1989年至2012年7月)和中国知网(1999年至2012年7月),纳入重组人血小板生成素临床应用的所有平行对照试验.结果 最后共7篇文章进入本系统综述.与重组人白细胞介素-11相比,重组人血小板生成素可改善血小板最低值[加权均数差1.76,95％可信区间(0.08,3.43),P=0.04],提高血小板最高值[加权均数差74.87,95％可信区间(52.54,97.20),P＜0.00001],缩短血小板≤50×109/L的持续时间[加权均数差-1.61,95％可信区间(-2.03,-1.19),P＜0.000 01],缩短血小板恢复至≥75×10g/L[加权均数差-3.74,95％可信区间(-4.29,-3.19),P＜0.000 01]及恢复至≥100×109/L[加权均数差-3.35,95％可信区间(-4.27,-2.42),P＜0.000 01]的时间.且血小板输注比例[相对危险度0.39,95％可信区间(0.23,0.66),P=0.000 5]及不良反应发生比例[相对危险度0.20,95％可信区间(0.13,0.31),P＜0.000 03]更低.结论 目前的证据表明,重组人血小板生成素与重组人白细胞介素-11相比,应用于国内患者临床疗效更佳,不良反应更少.

Meta Analysis of Recombinant Chemotherapy Induced Human Thrombopoietin in Thrombocytopenia

Objective To investigate whether recombinant human thrombopoietin （rhTPO） is better than recombinant human interleukin-11 （rhlL-11 ）. Methods Meta-analysis was conducted with all the qualified clinical randomized trials which compared rhTPO with rhlL-11 in chemotherapy induced thrombocytopenia （CIT）. Database includes CBM disc, Wanfang data resource, China Science and Technology Periodical Database and CNKI, and the censor data was up to July 2012. All the calculations and statistical tests were done with the RevMan 5 software. Results Finally, 7 trials achieved all the criteria. Compared with rhlL-11, rhTPO can further improve the minimum value of blood platelet [WMD 1.76, 95%CI（0.08, 3.43）, P=0.04], increase the maximum value of blood platelet [WMD 74.87, 95%CI（52.54, 97.20）, P〈0.000 01 ], shorten the time interval for blood platelet less than 50~109/L [WMD -1.61, 95%CI（-2.03, -1.19）, P〈0.000 01 ], more quickly to help blood platelet elevated above to 75x109/L [WMD-3.74, 95%CI（-4.29, -3.19）, P〈0.000 01] and 100×10^9/L [WMD-3.35, 95%CI（-4.27, -2.42）, P〈 0.000 01]. In addition, the proportion of blood infusion [RR 0.39, 95%CI（0.23, 0.66）, P=0.000 5] and adverse effects were lower [RR 0.20, 95%CI（0.13,0.31）, P〈0.000 03]. Conclusions rhTPO has better remarkable efficacy and less adverse reaction than rhlL-11.