中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (26): 4791-4795.doi: 10.3969/j.issn.1673-8225.2010.26.010

• 骨与关节综述 bone and joint review • 上一篇    下一篇

唑来膦酸与帕米膦酸二钠治疗恶性肿瘤骨转移疼痛：疗效与安全性对比的Meta分析

王 凯1，王栓科1，赵 斌1，王 娜2   

  1. 1兰州大学第二医院骨科，甘肃省兰州市  730000；  
    2兰州大学第一医院肿瘤科，甘肃省兰州市 730000
  • 出版日期:2010-06-25 发布日期:2010-06-25
  • 通讯作者: 王栓科，博士，博士生导师，主要从事脊柱外科，关节外科方面的研究。兰州大学第二医院骨科，甘肃省兰州市730000 wskzzzy@yahoo.com.cn
  • 作者简介:王 凯，男，1981年生，硕士在读，住院医师，主要从事骨肿瘤、人工关节方向的研究。 56966186@ qq.com

Zoledronic acid and pamidronate disodium for treating malignant bone metastasis pain: A Meta-analysis of effectiveness and safety

Wang Kai1, Wang Shuan-ke1, Zhao Bin1, Wang Na2   

  1. 1Department of Orthopedics, Second Hospital of Lanzhou University, Lanzhou  730000, Gansu Province, China;
    2Department of Oncological Surgery, First Hospital of Lanzhou University, Lanzhou  730000, Gansu Province, China
  • Online:2010-06-25 Published:2010-06-25
  • Contact: Wang Shuan-ke, Doctor, Doctoral supervisor, Department of Orthopedics, Second Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China wskzzzy@yahoo．com.cn
  • About author:Wang Kai, Studying for master’s degree, Physician, Department of Orthopedics, Second Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China 56966186@qq.com

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摘要：

背景：肿瘤骨转移是癌性疼痛的主要原因之一，第三代双磷酸盐的唑来磷酸与第二代的帕米膦酸二钠对治疗恶性肿瘤骨转移引起的疼痛有着给药时间短、给药剂量小、作用时间长的临床特点。

目的：评价唑来膦酸和帕米膦酸二钠治疗恶性肿瘤骨转移引起的骨痛所产生的不良反应和安全疗效。

方法：计算机检索Cochrane Library，PubMed，EMBase，中国生物医学文献数据库(CBM)中文期刊全文数据库和中文科技期刊全文数据库等数据库，手工检索所有纳入文献的参考文献。纳入唑来膦酸与帕米磷酸钠治疗恶性肿瘤骨转移引起的骨痛的随机对照试验。评价纳入研究的方法学质量并进行资料提取后，采用RevMan5.0软件进行Meta分析。

结果与结论：共10个随机对照试验2 731例患者纳入研究，其中3个随机对照研究来自美国，另7个来自中国；且10篇RCT 存在偏倚的可能性均为中等程度。唑来膦酸组与帕米膦酸二钠组治疗恶性肿瘤骨转移疼痛在完全缓解率，部分缓解率和总的有效率方面差异均无显著性意义(RR=1.59，95% CI：0.91~2.80；RR=0.95，95% CI：0.81~1.12；RR=1.04，95% CI：0.97~1.12)。在不良反应方面也无显著性意义，除了头痛外，其RR值和95% CI为(RR=0.82，95% CI： 0.70~0.96)。综上，唑来膦酸有效率及不良反应发生率与帕米膦酸二钠相当。

关键词: 唑来膦酸, 帕米膦酸钠, Meta分析, 恶性肿瘤, 疼痛, 安全性

Abstract:

BACKGROUND: Bone metastasis is a major reason for tumorous pain. The third generation of diphosphonate zoledronic acid and the second generation of pamidronate disodium display several clinical features in treating pain caused by bone metastasis, such as short administration, low dose and long effect.

OBJECTIVE: To assess the effectiveness and safety of zoledronic acid compared with pamidronate disodium in treatment of pain caused by bone metastasis of malignance neoplasms.

METHODS: A computer-based online search of Cochrane library, PubMed, EMBase, Chinese Biomedical Literature Database, China Journal Full-text Database, and Chinese Scientific Journal Full-text Database was performed. Randomized controlled trails (RCTs) on zoledronic acid and pamidronate in treatment of pain caused by bone metastasis of malignance neoplasms were identified. The methodological quality of the included studies was evaluated, and data analyses were performed using RevMan 5.0 software.

RESULTS AND CONCLUSION: A total of 10 randomized controlled trials involving 2 731 patients were studied. Of the 10 trials, 7 were performed in China, and 3 in the United States. Evaluation of the methodological quality showed that the 10 RCTs had a moderate risk of bias. The result of Meta-analysis showed that there was no significant difference in the complete response rate (CR rate), partial response rate or total effective rate, (RR = 1.59, 95% CI: 0.91-2.80) (RR = 0.95, 95% CI: 0.81-1.12) (RR = 1.04, 95% CI: 0.97-1.12). Significant difference was noted in side effects but headache (RR = 0.82, 95% CI: 0.70-0.96). As to response rate and side effect, zoledronic acid was similar to pamidronate.

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