结直肠癌术后患者中医证型及用药规律文献分析

目的通过文献分析归纳结直肠癌术后中医证型分布和用药规律。方法收集整理自1996—2016年中医药治疗结直肠癌术后患者的文献,采用改良Jadad评分量表对随机对照临床试验进行评价,对所选文献中的中医证型分布、中药使用频次等进行统计归类。结果在检索出的1 746篇文献筛选出16篇文献,其中12篇为随机对照临床试验,纳入文献共涉及1 509例患者,其中966例患者接受中医治疗。12篇随机对照临床试验的Jadad评分均低于3分,为低质量临床试验。文献中证型分布频率依次是:脾肾阳虚(23.6%)、气血亏虚(23.2%)、脾虚湿盛(19.5%)、脾气亏虚(16.5%)、气滞血瘀(11.2%)、肝肾阴虚(6.0%)。方剂中涉及64味中药,其中以白术、茯苓、甘草、黄芪、党参为代表的健脾益气类中药比例较多。5篇文献(31.3%)报告了卡氏评分,差异均有统计学意义(P<0.05)。结论结直肠癌术后的中医证型以"脾虚"为主要表现,兼有肾虚、痰湿、气滞、血瘀等,中医治法以健脾益气最为常见。

Literature Evaluation of Chinese Medicine Syndrome Types and Medication Rules in Postoperative Patients with Colorectal Cancer

Objective To summarize the distribution of Chinese medicine(CM) syndrome types and the regularity of drugs used in postoperative patients with colorectal cancer by frequency analysis. Methods We collated the literature of postoperative patients with colorectal cancer treated by CM from 1996 to 2016. The modified Jadad scale was used to evaluate randomized controlled clinical trials. The CM syndrome types and the use of Chinese herbal medicine in the selected dissertation were statistically classified. Results Totally 16 papers were selected according to the criteria of the review in the retrieved 1 746 articles, including 12 randomized controlled clinical trials. A total of 1 509 patients were included in the literature, 966 patients were treated with CM. The Jadad scores of the 12 randomized controlled clinical trials were less than 3 points, which were low quality clinical trials. The pattern distribution frequency was: deficiency of Pi and Shen(23.6%), deficiency of qi and blood(23.2%),Pi deficiency induced damp abundance(19.5%), deficiency of Pi-qi(16.5%), qi stagnation and blood stasis(11.2%), Gan-Shen yin deficiency(6.0%). There were 64 Chinese herbs in the 16 papers. The proportion of herbs for invigorating Pi and benefiting Qi had obvious advantages, such as Atractylodes macrocephala Koidz., Poria cocos, Glycyrrhiza uralensis, Astragalus membranaceus, Radix Codonopsis. Five papers(31.3%) reported the KPS score, all of the differences were statistical significant(P<0.05). Conclusions CM syndrome type of postoperative patients with colorectal cancer were characterized by Pi deficiency complicated with Shen deficiency, phlegm dampness, qi stagnation and blood stasis syndrome. "Strengthening Pi and supplementing qi" was the most common CM treatment for postoperative patients with colorectal cancer.