中药联合唑来膦酸治疗肺癌骨转移的系统评价

Systematic Evaluation of Traditional Chinese Medicine Combined with Zoledronic Acid Treatment for Lung Cancer with Bone Metastasis

目的:通过对比中药联合唑来膦酸治疗肺癌骨转移与单纯唑来膦酸治疗肺癌骨转移的疗效,以寻求中医药在治疗肺癌骨转移方面增效减毒的有力证据,为临床提供服务。方法:检索中国知网、维普、万方、PubMed、Embase及CMB数据库自建库至2018年3月发表的有关于中医药联合唑来膦酸治疗肺癌骨转移的随机对照试验,按Cochrane系统评价方法并采用Revman5.3对结果进行进行Meta分析。结果:共选入14项研究,包括847名患者,与对照组相比,中药联合唑来膦酸组在降低患者疼痛评分(RR=1.50,95%CI=1.35-1.68,P <0.00001)、提高患者生活质量(RR=1.47,95%CI=1.27-1.70,P <0.00001)、改善患者中医证候(RR=5.69,95%CI=2.26-14.34,P=0.0002)、延长TTP(MD=1.16,95%CI=0.74-1.58,P <0.00001)、降低血清钙(MD=-0.32,95%CI=-0.46--0.17,P <0.0001)、减少不良反应的发生(RR=0.51,95%CI=0.32-0.81,P=0.005)方面具有独特的作用和优势。结论:中药联合唑来膦酸治疗肺癌骨转移具有显著的疗效性,安全性好,可在临床上推广使用。

Objective: To prove the effect and decrease toxicity in the treatment of lung cancer with bone metastasis of Traditional Chinese medicine and provide service for clinical by comparing the efficacy of traditional Chinese medicine combined with zoledronic acid with pure zoledronic acid in the treatment of lung cancer with bone metastasis. Methods: A retrieval was made for randomized controlled trials of traditional Chinese medicine combined with zoledronic acid in the treatment of lung cancer with bone metastasis which have been included in CNKI, VIP, Wanfang, PubMed, EMbase and CMB to March, 2018, and meta-analysis was performed according to Cochran systematic evaluation method and Revman5.0. Results: A total of 14 RCTs and 847 patients were included. Compared with control group, ache in the Traditional Chinese medicine combined with zoledronic acid group remarkably decreased(RR = 1.50, 95%CI = 1.35-1.68, P <0.000 01), while the living quality remarkably increased(RR = 1.47, 95%CI = 1.27-1.70, P < 0.000 01), and there were significant role and advantages in improving TCM syndromes of patients(RR = 5.69, 95%CI = 2.26-14.34, P = 0.000 2),prolonging TTP(MD = 1.16, 95%CI = 0.74-1.58, P < 0.000 01), decreasing serum calcium(MD =-0.32, 95%CI =-0.46--0.17, P < 0.000 1) and reducing adverse reactions(RR = 0.51, 95%CI = 0.32-0.81, P = 0.005). Conclusion:Traditional Chinese medicine combined with zoledronic acid has remarkable curative efficacy and safety in the treatment of lung cancer with bone metastasis, and it may be widely used in clinical practice.