Page 109 - 《中国药房》2024年10期

literature， extracting data and evaluating quality， meta-analysis was performed by using RevMan 5.3 software. RESULTS A total
of 11 studies were included， involving 1 321 patients. There was no correlation between the three genotypes and effective rate， the
incidence of myelosuppression， the incidence of neurotoxicity （except for the allele and recessive model of ABCB1 C1236T）， and
the incidence of hypersensitivity reactions （P＞0.05）. The subgroup analysis showed that there was a correlation between ABCB1
C1236T dominant model and effective rate when using anthracyclines+5-fluorouracil+cyclophosphamide+taxanes （P＜0.05）， there
was a correlation between ABCB1 C3435T recessive model and effective rate when using taxanes+trastuzumab （P＜0.05）. ABCB1
C1236T allele model and recessive model were correlated with sample size ≥100 and using cyclophosphamide+epirubicin+5-
fluorouracil+paclitaxel or cyclophosphamide+epirubicin+paclitaxel+trastuzumab or cyclophosphamide+epirubicin+5-fluorouracil+
trastuzumab+paclitaxel regimens； recessive model with sample size ＜100 and the African region were correlated with the incidence
of peripheral neuropathy； recessive model was correlated with cutaneous adverse reactions （P＜0.05）. ABCB1 C3435T recessive
model was correlated with the incidence of reduced neutrophil count with sample size ≥100； the incidence of white blood cell
count reduction with sample size ＜100 and using docetaxel+epirubicin+cyclophosphamide was correlated with both the allele model
and the dominant model； the incidence of infections was correlated with the dominant model （P＜0.05）. The incidence of
neutrophil count reduction with the sample size ＜100 was correlated with allele model of ABCB1 G2677T/A； the incidence of
edema with sample size ≥100 was correlated with allele model and recessive model； the incidence of infection was correlated with
allele model and dominant model， especially in patients with neutrophil count complicated with fever （P＜0.05）. CONCLUSIONS
ABCB1 genotypes are not correlated with effective rate of taxanes in the treatment of breast cancer， but ABCB1 C3435T genotype is
associated with decreased neutrophil counts， decreased white blood cell counts and infections； ABCB1 C1236T genotype is
associated with neurotoxicity and cutaneous adverse reactions； ABCB1 G2677T/A genotype is associated with decreased neutrophil
counts， infections， and edema.
KEYWORDS breast cancer； ABCB1 genotypes； gene polymorphism； paclitaxel； docetaxel； efficacy； safety

乳腺癌是女性最常见的恶性肿瘤之一，2022年我国 1 资料与方法
[1]
乳腺癌新发病例约43万例，死亡病例约12万例 。乳腺 1.1 纳入与排除标准
癌的治疗以手术治疗、放疗、化疗、免疫治疗、靶向治疗 1.1.1 研究类型
本研究纳入的文献类型为队列研究和病例-对照研
和内分泌治疗为主。紫杉烷类药物是早期、局部晚期和
究；语种为中文或英文。
[2]
转移性乳腺癌的一线治疗方案 ，在抑制乳腺癌的疾病
1.1.2 研究对象
进展中疗效显著，但存在个体差异，紫杉烷类药物代谢
本研究的对象为乳腺癌患者。
酶和转运体可能是造成差异的主要原因之一；此外，应 1.1.3 干预措施
用该类药物期间可能会出现骨髓抑制、神经毒性、胃肠 所有患者均单用紫杉烷类药物或联合其他药物。
[3]
道反应和过敏反应等不良反应 ，这可能会延长患者的 紫杉烷类药物包括：紫杉醇和多西他赛。
住院时间，严重者甚至危及生命。 1.1.4 结局指标
本研究的结局指标包括：（1）有效率；（2）不良反应
三磷酸腺苷结合盒转运体 B 亚家族成员 1（ATP-
发生率。
binding cassette subfamily B member 1，ABCB1）基因通
1.1.5 排除标准
过编码紫杉烷类药物代谢酶，来影响紫杉烷类药物的转
本研究的排除标准为：（1）基础实验研究；（2）重复
运蛋白。基因多态性与蛋白表达水平相关，若ABCB1功 发表的文献；（3）综述或系统评价；（4）数据不完整的
能改变或表达减少，可引起药物积累和药物毒性，从而 研究。
导致治疗失败 。据文献报道，紫杉烷类药物的疗效与 1.2 文献检索策略
[3]
ABCB1 C1236T 、ABCB1 C3435T 和 ABCB1 G2677T/ 检索 Embase、Cochrane 图书馆、PubMed、中国知网
[5]
[4]
[6]
[7]
A 相关，但也有研究者认为二者并无相关性 。此外， 和万方数据。英文检索词为“taxane”“taxol”“paclitaxel”
“docetaxel”“ABCB1”“MDR1”“gene”“gene polymor‐
紫杉烷类药物所致的骨髓抑制、神经毒性等不良反应与
phism”“genetic polymorphism”“polymorphism”“breast
ABCB1 基因型之间的关系也尚无一致结论 [8―9] 。为此，
cancer”；中文检索词为“紫杉烷”“紫杉醇”“多西他赛”
本研究采用Meta分析的方法对ABCB1基因型与紫杉烷 “ABCB1”“MDR1”“基因”“基因型”“多态性”“乳腺癌”。
类药物用于乳腺癌的有效性和安全性的相关性进行评 采用主题词与自由词相结合的方式检索，检索时限为建
价，旨在为临床用药提供循证依据。 库起至2023年7月。

中国药房 2024年第35卷第10期 China Pharmacy 2024 Vol. 35 No. 10 · 1255 ·