益气活血法治疗非小细胞肺癌的Meta分析

Meta Analysis on the Treatment of Non-small Cell Lung Cancer by Invigorating Qi and Activating Blood Circulation

目的客观评价中医益气活血法治疗非小细胞肺癌的近期有效率、KPS评分、免疫功能、凝血功能及骨髓抑制的发生,为临床应用益气活血法治疗NSCLC提供理论指导。方法计算机检索The Cochranne Library、PubMed、EMbase、中国生物医学文献数据库、中国期刊全文数据库、维普数据库、万方数据服务平台,2名研究者按照Cochrane评价标准单独筛选文献、提取资料,最终纳入10个研究,共340例非小细胞肺癌患者,运用软件RevMan5.3作Meta分析。结果Meta分析结果显示:运用益气活血法治疗NSCLC,患者近期有效率[OR=1.87,95%CI=(1.36,2.58)]、KPS[OR=3.45,95%CI=(1.55,7.72)]的结果明显优于对照组;免疫功能指标CD3+[WMD=7.07,95%CI=(1.75,13.58)]、CD4+[WMD=9.30,95%CI=(5.71,12.89)]、CD4+/CD8+[WMD=0.54,95%CI=(0.28,0.62)]、NK[WMD=4.05,95%CI=(1.93,6.17)]较对照组明显提高,而CD8+[WMD=-3.30,95%CI=(-4.95,-1.65)]降低;凝血相关指标PT[WMD=3.41,95%CI=(3.04,3.77)]、APTT[WMD=2.26,95%CI=(0.09,4.43)]较对照组明显改善,FIB[WMD=-1.22,95%CI=(-2.55,-1.10)]无显著性差异;非小细胞肺癌患者化疗骨髓抑制的发生[OR=0.31,95%CI(0.14,0.68)]明显低于对照组。临床使用益气活血中药频数居前10位置的分别为黄芪、白术、白花蛇舌草、茯苓、半枝莲、人参、川芎、当归、莪术、三七。结论目前证据显示临床治疗非小细胞肺癌时,应当注重中医益气活血法的应用,益气活血法配合化疗能够提高患者短期有效率,提高非小细胞肺癌患者免疫功能及改善血液高凝状态,改善患者生活质量。

Objective Objective To evaluate the short-term efficacy,KPS score,immune function,coagulation function and bone marrow depression of the treatment of non-small cell lung cancer by Invigorating Qi and activating blood circulation,and to provide guidance for clinical application of Invigorating Qi and activating blood circulation in the treatment of NSCLC.Methods PubMed,the Cochranne Library,CBM,EMbase,CNKI,Wanfang and VIP databases were searched by computer.The two researchers screened the literature and extracted the data separately according to the Cochrane evaluation criteria,and used the software RevMan5.3 for Meta analysis.A total of 340 NSCLC patients were eventually included in 10 studies.Results A total of 340 NSCLC patients were included in 10 studies.Results of meta-analysis showed that the short-term effective rate[OR=1.90,95%CI=(1.41,2.55))]and KPS[OR=3.45,95%CI=(1.55,7.72))of patients treated with NSCLC by invigorating qi and activating blood circulation method were significantly better than that of the control group.Immune index CD3+(WMD=7.07,95%CI=(1.75,13.58)],CD4+(WMD=9.30,95%CI=(5.71,12.89)],CD4+/CD8+(WMD=0.54,95%CI=(0.28,0.62)],NK(WMD=4.05,95%CI=(1.93,6.17)]was improved obviously,and CD8+(WMD=3.30,95%CI=(4.95,1.65)];Related parameters of blood coagulation PT(WMD=3.41,95%CI=(3.04,3.77)],PTT(WMD=2.26,95%CI=(0.09,4.43)]was obviously improved,FIB(WMD=1.22,95%CI=(2.55,1.10)]there was no significant difference;The incidence of chemotherapeutic bone marrow suppression in NSCLC patients[OR=0.31,95%CI(0.14,0.68)]was significantly lower than that in the control group.The ten most frequently used TCM in clinic were Huangqi,Baizhu,Baihuasheshecao,Fuling,Banzhilian,Renshen,Chuanxiong,Danggui,Ezhu and Sanqi,respectively.Current evidence suggests that in clinical treatment of NSCLC,attention should be paid to the application of TCM invigorating qi and activating blood circulation method.Conclusion Adjuvant chemotherapy can improve short-term effective rate,quality of life,immunity and hypercoagulation of NSCLC patients.