论文部分内容阅读
目的:系统评价8种化疗方案治疗低危妊娠滋养细胞肿瘤的有效性及安全性。方法:计算机检索PubMed、Cochrane图书馆、EMbase、Medline、万方、维普、中国知网等数据库，检索时限从建库至2019年10月，使用Stata 13.0绘制网状关系图，分别使用Revman 5.3和GeMTC软件进行直接和网状Meta分析。结果:最终纳入13篇随机对照试验，共使用8种化疗方案。直接Meta分析显示，放线菌素D单日冲击方案初治完全缓解（PCR）率优于甲氨蝶呤单日冲击方案，差异具有统计学意义（n OR=0.21，95%n CI 0.08～0.55，n P100；n OR>100，95%n CI下限1.84，上限> 100）；甲氨蝶呤+叶酸8 d方案、甲氨蝶呤单日冲击方案、放线菌素D单日冲击方案血小板减少发生率均低于放线菌素D 5 d方案，差异均具有统计学意义（n OR=0.00，95%n CI 0.00～0.75；n OR=0.00，95%n CI 0.00～0.28，n OR>100，95%n CI下限1.35，上限>100，均n P100;n OR > 100, 95% n CI 1.84->100). The incidence of thrombocytopenia in 8 d-MTX + folic acid, pulsed MTX and pulsed act-D was lower than that in 5 d-act-D, and the differences were statistically significant (n OR = 0.00, 95%n CI 0.00-0.75; n OR = 0.00, 95% n CI 0.00-0.28; n OR > 100, 95% n CI 1.35->100, alln P < 0.05). Pulsed MTX and pulsed act-D was lower than that in MTX+act-D, and the differences were statistically significant ( n OR = 0.00, 95%n CI 0.00-0.27; n OR = 0.00, 95% n CI 0.00-0.72). The probability ranking diagram showed that 5 d-act-D and MTX+ act-D had more advantages in terms of effectiveness; in terms of safety, pulsed MTX and pulsed act-D had better therapeutic effects.n Conclusions:MTX+act-D and 5 d-act-D have higher PCR rate and shorter treatment cycle. However, the incidence of adverse reactions, such as thrombocytopenia is higher compared with other treatment regimens. It is necessary to do more high-quality and large-scale researches to find out the optimal plan.