中药注射液联合含奥沙利铂化疗方案治疗大肠癌的网状Meta分析

Network Meta-analysis of Chinese Medicine Injections Combined with L-OHP-based Chemotherapy Regimen in Treating Colorectal Neoplasms

摘要:

目的：采用网状Meta分析评价中药注射液（CMI）联合含奥沙利铂（L-OHP）化疗方案治疗大肠癌的疗效和安全性，为临床提供循证参考。方法：计算机检索中国期刊全文数据库，万方数据库，中国生物医学文献数据库，中文科技期刊数据库，PubMed，Embase（各数据库建库起至2016年11月20日），收集中药注射液联合含L-OHP化疗方案对比单纯含L-OHP化疗方案治疗大肠癌的随机对照试验（RCT），提取资料并依据改良的Jadad量表进行质量评价后，采用ADDIS软件进行网状Meta分析。结果：最终纳入14种CMI，64项RCTs，合计5 081例患者。纳入文献有4篇高质量。网状Meta分析结果显示：①对比单纯化疗，3种CMI联合含L-OHP的化疗方案能提高临床有效率（WHO标准），7种CMI能提高患者生活质量、降低白细胞减少，6种CMI能减少恶心呕吐，4种CMI能减少周围神经毒性，差异有统计学意义；②在降低周围神经毒性方面，黄芪注射液优于艾迪注射液，参麦注射液优于复方苦参注射液、康艾注射液，差异有统计学意义，其余两两之间的对比差异无统计学意义。结论：目前证据支持中药注射液联合含L-OHP化疗方案治疗大肠癌优于单纯化疗。受纳入文献方法学质量限制，该研究有待大样本及更多高质量的RCT进一步验证。

Abstract:

Objective: To evaluate the therapeutic effect and safety of Chinese medicine injection (CMI) combined with Oxaliplatin-based chemotherapy regimen in treating colorectal neoplasms. Method: CNKI, Wanfang, CBM, VIP, PubMed, Cochrane Library and other databases (as at November 20^th 2016) were retrieved to collect relevant journals of RCTs. The quality of RCTs was assessed by Jadad scores, and network Meta-analysis was performed by ADDIS software. Result: A total of 64 articles (including 14 CMI) were included, involving 5 081 patients. Finally, four high-quality literatures were included. According to network Meta-analysis, ① compared with chemotherapy, three CMIs could improve the effective rate; seven CMIs could improve quality of life and reduce leukopenia; six CMIs could reduce the nausea and vomiting; four CMIs could reduce peripheral nerve toxicity, with statistically significant differences. ② In reduction of peripheral nerve toxicity, Huangqi injection was better than Aidi injection, Shenmai injection was better than compound Kushen injection or Kangai injection, with statistically significant differences. The other two showed no tatistically significant difference. Conclusion: Due to the limitation of the included studies, our findings also need to be further verified by large-scale and high-quality RCTs.