中医辨证论治联合化疗治疗晚期非小细胞肺癌的Meta分析

目的:系统评价中医辨证论治联合化疗方案治疗晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的临床效果以及安全性。方法:计算机检索The Cochrane Library,Pubmed,Embase,中国科技期刊全文数据库(VIP),万方数据库,中国期刊全文数据库(CNKI),中国生物医学文献数据库(CBM)等,检索时间限定为建库至2015年7月5日,检索所有中医辨证论治联合化疗方案治疗晚期非小细胞肺癌的随机对照试验(randomized controlled trials,RCTs),并追索纳入研究的参考文献。由两位评价者独立对纳入研究的质量进行严格评价和资料提取后,采用Rev Man 5.3软件进行Meta分析。结果:最终纳入12项RCT,共1 341例患者。Meta分析结果显示:与单纯化疗相比,中医辨证论治联合化疗方案可有效提高临床近期疗效OR=1.58,95%CI(1.03,2.42),P=0.03],改善患者生存质量OR=4.38,95%CI(3.17,6.05),P0.000 01]。不良反应方面,中医辨证论治联合化疗方案能减少化疗引起的骨髓抑制:白细胞下降OR=0.21,95%CI(0.10,0.44),P0.000 1],血红蛋白下降OR=0.29,95%CI(0.13,0.68),P=0.004],血小板下降OR=0.26,95%CI(0.10,0.69),P=0.007],减少消化道不良反应OR=0.23,95%CI(0.09,0.63),P=0.004],但在减少肝功能损害OR=0.37,95%CI(0.08,1.66),P=0.19],肾功能损害OR=0.51,95%CI(0.23,1.14),P=0.10]方面两组差异均无统计学意义。结论:中医辨证论治联合化疗方案治疗晚期非小细胞肺癌能有效提高临床近期疗效和改善患者生存质量,减少化疗引起的严重骨髓抑制和消化道不良反应,但在减少肝肾功能损害方面和单纯使用化疗方案相比无显著性差异。鉴于本研究纳入RCTs数量和质量有限,中医辨证论治联合化疗方案治疗晚期非小细胞肺癌的临床疗效以及安全性仍需要严格的、大样本的随机双盲试验加以验证。

Meta-analysis of Efficacy of Traditional Chinese Medicine Dialectical Treatment Combination with Chemotherapy in Advance Non-small Cell Lung Cancer

Objective:To study the safety and efficacy of traditional Chinese medicine(TCM) dialectical treatment combination with chemotherapy in advance non-small cell lung cancer(NSCLC). Method:We searched The Cochrane Library, Pubmed, Embase, VIP, Wangfang Data,CNKI,CBM, from database inception to July5, 2015.Randomized controlled trials (RCTs) of TCM dialectical treatment combination with chemotherapy in advance non-small cell lung cancer in any language were included, and recover into research references. Two researchers extracted data and assessed the literature quality separatedly, and made a Meta analysis RevMan 5.3 software. Result:The 12 RCTs involving 1341 patients entered the inclusion criteria. The Meta-analysis results showed that compared with the pure application of chemotherapy regimens, TCM dialectical treatment combination with chemotherapy can significantly improve the patients quality of lifeOR=1.58,95%CI(1.03,2.42),P=0.03], curative effect in the near futureOR=4.38,95%CI(3.17,6.05),P<0.00001]. Adverse reactions, TCM dialectical treatment combination with chemotherapy can reduce bone marrow suppression caused by chemotherapy (white blood cells declineOR=0.21,95%CI(0.10,0.44),P<0.0001], hemoglobin declineOR=0.29,95%CI(0.13,0.68),P=0.004], platelet declineOR=0.26,95%CI(0.10,0.69),P=0.007], digestive tract reactionsOR=0.23,95%CI(0.09,0.63),P=0.004],but in the liver function damageOR=0.37,95%CI(0.08,1.66),P=0.19], renal impairmentOR=0.51,95%CI(0.23,1.14),P=0.10] were no significant differences. Conclusion:The current results indicates that TCM dialectical treatment combination with chemotherapy in advance non-small cell lung cancer can effectively improve the quality of survival, near future curative effect,reduce severe bone marrow suppression caused by chemotherapy, and gastrointestinal adverse reactions,but liver and kidney function damage and simple scheme there was no significant difference compared with chemotherapy. However, the efficacy and safety of TCM dialectical treatment combination with chemotherapy in advance non-small cell lung cancer still need more strict, large sample, randomized, double-blind trials to verify.