中药注射剂联合肝动脉插管栓塞化疗术治疗肝癌的网状Meta分析

Network Meta-analysis of Chinese Medicine Injections Combined with Transcatheter Arterial Chemoembolization for Liver Cancer

目的:采用网状Meta分析评价不同中药注射剂联合肝动脉插管栓塞化疗术(TACE)治疗肝癌的有效性和安全性。方法:计算机检索Pub Med,The Cochrane Library,EMBASE,CBM,CNKI,万方和维普数据库,检索时间均从建库起截止2015年3月,纳入中药注射剂联合TACE对比单纯TACE治疗肝癌的随机对照试验(RCTs),并按预先制定的纳入与排除标准筛选和纳入文献,由2名研究者独立对纳入的RCTs进行数据提取和质量评价,采用Win Bugs 1.4软件对数据进行贝叶斯网状Meta分析。结果:最终纳入91个RCTs,共计6 493例患者,网状Meta分析结果显示:7种中药注射剂联合TACE对比单独TACE治疗方案在提高肝癌治疗的有效率和患者的生活质量、降低呕心呕吐、肝功能异常和白细胞减少发生率方面均显示出其优越性;在治疗肝癌的有效性方面康艾+TACE,复方苦参+TACE,艾迪+TACE,康莱特+TACE,华蟾素+TACE和鸦胆子油乳+TACE的疗效优于黄芪多糖+TACE,而其他注射液+TACE之间的差异无统计学意义;在提高生活质量方面复方苦参+TACE比艾迪+TACE更具优势;而在减少恶心呕吐和白细胞的发生率方面7种注射液+TACE之间均无统计学意义。结论:网状Meta分析的结果表明,7种中药注射剂联合TACE治疗肝癌的疗效和安全性均优于单独TACE疗法,且根据概率排序结果显示:在提高有效率方面,康艾联合TACE较其他种6中药联合TACE相对有效,而在改善生活质量情况方面,华蟾素注射液联合TACE较其他6种药联合TACE相对有效。

Objective： To assess the clinical effects and safety of Chinese medicine injection combined with transcatheter arterial chemoembolization（ TACE） for liver cancer by using network Meta-analysis. Method：The randomized controlled trials（ RCTs） of Chinese medicine injections（ CMIs） combined with TACE VS TACE alone for liver cancer were searched from Pub Med,The Cochrane Library,EMBASE,CBM,Chinese Knowledge Infrastructure（ CNKI）,Wanfang,and Chinese Scientific Journals Fulltext Database（ VIP-CSJFD）,up to March2015 since database establishment. The RCTs were screened and selected according to the predefined inclusion and exclusion criteria Data extraction and quality evaluation were done for the included RCTs by 2 independent researchers,and Bayesian network meta-analysis was done by using Win Bugs 1. 4 software. Result： The 91 RCTs including 6 493 patients were finally included. The results of network Meta-analysis showed that 7 kinds of CMIs combined with TACE were superior to TACE alone in the treatment of liver cancer in increasing effective rate and life quality,reducing nausea and vomiting,abnormal liver function and leukopenia incidence. In terms of efficacy for liver cancer,Kang＇ai injection ＋ TACE,Fufang Kushen injection ＋ TACE,Aidi injection ＋ TACE,Kanglaite injection ＋ TACE,cinobufagin injection ＋ TACE,and bruceolic oil emulsion injection ＋ TACE were superior to astragalus polysaccharide injection ＋ TACE,whereas there was no statistically significant difference with other injections ＋ TACE. In terms of improving life quality, Fufang Kushen injection ＋ TACE was prior to Aidi injection ＋ TACE. There was no statistically significant difference among the 7 CHIs in reducing the incidence of nausea,vomiting and leukopenia. Conclusion： Based on the results of network Meta-analysis,7 CHIs combined with TACE have better efficacy and safety than TACE alone for liver cancer. Based on the probability ranking results,Kang＇ ai injection ＋ TACE is more effective as compared with other 6 CHIs ＋ TACE for increasing effective rate,and cinobufagin injection ＋ TACE is more effective as compared with other 6 CHIs ＋ TACE for improving the quality of life.