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目的:比较持续静脉缓慢滴注和静脉推注蒽环类药物心脏毒性的发生风险。方法:系统检索Cochrane图书馆、Elsevier、PubMed、Embase、CNKI、万方等数据库,纳入国内外已公开发表的有关比较持续静脉缓慢滴注和静脉推注蒽环类药物治疗肿瘤患者后心脏毒性发生风险的研究。检索截止日期为2016年5月,采用RevMan 5.3软件对数据进行荟萃分析,计算合并后的相对危险度(RR)及其95%可信区间(CI)。结果:共纳入11篇文献,包括967例患者,所有患者蒽环类药物治疗前均无心脏病史。荟萃分析显示:与持续静脉缓慢滴注相比,静脉推注蒽环类药物患者心脏毒性总体发生风险增加(RR=1.26,95%CI:1.06~1.51,P=0.01);亚组分析发现,成人肿瘤患者中,静脉推注蒽环类药物患者的心脏毒性发生风险是持续静脉缓慢滴注蒽环类药物患者的2.06倍(RR=2.06,95%CI:1.41~3.02;P<0.001),而在儿童肿瘤患者中,持续静脉缓慢滴注和静脉推注蒽环类药物相比,心脏毒性发生风险无统计学差异(RR=1.01,95%CI:0.83~1.23,P=0.93)。结论:与静脉推注相比,持续静脉缓慢滴注蒽环类药物可降低成人肿瘤患者心脏毒性发生风险,却不能降低儿童肿瘤患者心脏毒性的发生风险。
OBJECTIVE: To compare the risk of cardiotoxicity of anthracyclines with slow intravenous infusion and intravenous bolus injection. Methods: The Cochrane Library, Elsevier, PubMed, Embase, CNKI and Wanfang databases were searched systematically and included in the published reports of cardiotoxicity published in China and abroad for the comparison of continuous intravenous slow intravenous drip and intravenous bolus anthracycline therapy in patients with cancer Risk research. The deadline for the search was May 2016. Meta-analyzes were performed using RevMan 5.3 software to calculate the combined relative risk (RR) and its 95% confidence interval (CI). Results: A total of 11 articles were included, including 967 patients. All patients had no history of anthracycline prior to treatment. In a meta-analysis, there was an overall increased risk of cardiac toxicity with intravenous bolus anthracycline (RR = 1.26, 95% CI: 1.06 to 1.51, P = 0.01) Among adult cancer patients, the risk of developing cardiotoxicity with intravenous anthracycline was 2.06-fold (RR = 2.06, 95% CI: 1.41 to 3.02; P <0.001) In pediatric cancer patients, there was no statistically significant difference in the risk of cardiotoxicity between continuous intravenous drip and intravenous anthracyclines (RR = 1.01, 95% CI: 0.83-1.23, P = 0.93). CONCLUSIONS: Slow intravenous infusion of anthracyclines, compared with intravenous bolus, reduces the risk of cardiotoxicity in adult cancer patients but does not reduce the risk of cardiotoxicity in pediatric cancer patients.