Page 120 - 《中国药房》2022年5期

·循证药学·

吉西他滨联合顺铂治疗晚期非小细胞肺癌的系统评价再评价 Δ

黄纯碧 ，李卫平，许汝福，张 蓉（陆军军医大学第二附属医院药剂科，重庆 400037）
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中图分类号 R734.2；R979.1 文献标志码 A 文章编号 1001-0408（2022）05-0622-06
DOI 10.6039/j.issn.1001-0408.2022.05.19

摘 要 目的 再评价吉西他滨联合顺铂治疗晚期非小细胞肺癌（NSCLC）的系统评价，以期为 NSCLC 的治疗提供循证依据。
方法 计算机检索万方数据库、中国知网、维普网、PubMed和Embase，纳入吉西他滨联合顺铂对比培美曲塞/长春瑞滨联合顺铂治
疗晚期 NSCLC 的系统评价，检索时限为各数据库建库起至 2021 年 12 月。采用 RevMan 5.3 系统评价软件对各项结局指标进行
Meta分析；方法学质量评价采用AMSTAR2量表，证据质量评价采用GRADE工具。结果 共纳入9篇文献，Meta分析结果显示，吉
西他滨联合顺铂的有效率显著低于培美曲塞联合顺铂，但与长春瑞滨联合顺铂相当；吉西他滨联合顺铂的1年生存率与培美曲塞
联合顺铂相当，但显著高于长春瑞滨联合顺铂；吉西他滨联合顺铂的恶心呕吐发生率与培美曲塞/长春瑞滨联合顺铂相当；吉西他
滨联合顺铂的血小板减少发生率显著高于培美曲塞/长春瑞滨联合顺铂；吉西他滨联合顺铂的中性粒细胞减少发生率和白细胞减
少发生率均高于培美曲塞联合顺铂，但显著低于长春瑞滨联合顺铂。AMSTAR2量表评价结果显示，6篇系统评价为方法学低质
量，3篇为极低质量。GRADE工具分级结果显示，结局指标中的中等质量证据占31％（14项），低质量证据占27％（12项），极低质
量证据占42％（19项）；研究的局限性及发表偏倚是降级的主要因素。结论 吉西他滨联合顺铂治疗晚期NSCLC的有效性与安全
性较长春瑞滨联合顺铂有优势，特别是在1年生存率、中性粒细胞减少发生率和白细胞减少发生率方面；吉西他滨联合顺铂的有
效性与安全性不优于培美曲塞联合顺铂。但考虑到纳入系统评价的方法学质量和证据等级，其整体研究质量还有待提高。
关键词 吉西他滨；培美曲塞；长春瑞滨；顺铂；非小细胞肺癌；系统评价再评价

Reevaluation of systematic evaluation of gemcitabine combined with cisplatin in the treatment of advanced
non-small cell lung cancer
HUANG Chunbi，LI Weiping，XU Rufu，ZHANG Rong（Dept. of Pharmacy，the Second Affiliated Hospital of
Army Medical University，Chongqing 400037，China）

ABSTRACT OBJECTIVE To reevaluate the systematic evaluation of gemcitabine combined with cisplatin in the treatment of
advanced non-small cell lung cancer （NSCLC），in order to provide evidence-based evidence for the treatment of NSCLC.
METHODS Retrieved from Wanfang database，CNKI，VIP，PubMed，Embase，systematic evaluation of gemcitabine combined
with cisplatin versus pemetrexed/vinorelbine combined with cisplatin in the treatment of advanced NSCLC was included from the
inception to Dec. 2021. RevMan 5.3 system evaluation software was used for meta-analysis of various outcome indicators；
AMSTAR2 scale was used for methodological quality evaluation，and GRADE tool was used for evidence quality evaluation.
RESULTS A total of 9 literatures were included. Meta-analysis showed that the effective rate of gemcitabine combined with
cisplatin was significantly lower than pemetrexed combined with cisplatin，but was similar to vinorelbine combined with cisplatin.
The 1-year survival rate of gemcitabine combined with cisplatin was equivalent to that of pemetrexed combined with cisplatin，but
was superior to vinorelbine combined with cisplatin. There was no significant difference in the incidence of nausea and vomiting
between gemcitabine combined with cisplatin and pemetrexed/vinorelbine combined with cisplatin. Gemcitabine combined with
cisplatin had a higher incidence of thrombocytopenia than pemetrexed/vinorelbine combined with cisplatin. The incidence of
neutropenia and leukopenia in gemcitabine combined with cisplatin were higher than pemetrexed combined with cisplatin，but were
significantly lower than vinorelbine combined with cisplatin. The evaluation results of AMSTAR2 scale showed that 6 systematic
evaluation were of low quality in methodology and 3 were of very low quality. The results of the GRADE tool showed that 31％ of
the outcome indicators were of medium quality（14 items），27％ were of low quality（12 items），and 42％ were of very low
quality （19 items）. Research limitations and publication bias
Δ 基金项目：重庆市临床药学重点专科建设项目（No.渝卫办发
were the most frequently downgraded factors. CONCLUSIONS
〔2020〕68号）
＊药师。研究方向：医院药学。电话：023-68774133。E-mail： Gemcitabine combined with cisplatin has advantages over
154854280@qq.com vinorelbine combined with cisplatin in the efficacy and safety
# 通信作者：主任药师，博士。研究方向：医院药学。电话： of advanced NSCLC，especially in the 1-year survival rate，
023-68755580。E-mail：xqpharmacylab@126.com the incidence of neutropenia and leucopenia. The efficacy and

·622 · China Pharmacy 2022 Vol. 33 No. 5 中国药房 2022年第33卷第5期