培土生金法联合化疗治疗非小细胞肺癌的系统评价

Method of Reinforcing Earth to Strengthen Metal plus Chemotherapy for Non-small Cell Lung Cancer:A Systematic Review and Meta-Analysis

目的系统评价培土生金法联合化疗治疗非小细胞肺癌的有效性和安全性。方法计算机检索Pub Med、EMBASE、中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP)、万方数据库,收集培土生金法联合化疗治疗非小细胞肺癌的随机对照研究,根据纳入标准及排除标准,筛选出符合标准的文献,采用Rev Man5.3进行系统评价。结果本次系统评价最终纳入10项RCT研究,共865例受试者。Meta分析结果显示,培土生金法联合化疗治疗非小细胞肺癌患者的疗效和生活质量均优于单纯化疗组[OR=1.86,95%CI(1.37,2.53),P<0.0001;OR=2.67,95%CI(1.93,3.70),P<0.00001];在安全性方面,培土生金法联合化疗治疗非小细胞肺癌的III°~IV°白细胞下降、恶心呕吐、肝功能受损发生率均低于单纯化疗组[OR=0.38,95%CI(0.24,0.61),P<0.0001;OR=0.38,95%CI(0.19,0.77),P=0.007;OR=0.16,95%CI(0.05,0.55),P=0.004],但是在改善血红蛋白和血小板下降方面并不明显[OR=0.60,95%CI(0.26,1.36),P=0.22;OR=0.53,95%CI(0.29,0.97),P=0.04]。结论当前有限证据表明,培土生金法联合化疗治疗非小细胞肺癌较单纯化疗组疗效更优,且能改善患者白细胞下降、恶心呕吐及肝功能受损副反应,由于本次研究所纳入的文献质量较低,上述结论仍需要多中心大样本严格设计的随机对照试验进一步验证。

Objective To assess the effectiveness and safety of method of reinforcing earth to strengthen metal plus chemotherapy for patients with non-small cell lung cancer（NSCLC） through systematic review. Methods To include eligible RCTs of method of reinforcing earth to strengthen metal plus chemotherapy vs. chemotherapy alone, we searched the following electronic databases：Pub Med,EMBASE,CNKI,CBM,VIP,and WANFANG according to inclusion criteria and exclusion criteria. Results Ten RCTs were eligible,and 865 patients in 10 RCTs were studied.The current study suggest that, compared with chemotherapy alone, treatment of NSCLC patients with method of reinforcing earth to strengthen metal plus chemotherapy is asscociated with higher efficiency and quality of life（OR=1.86,95 % CI[1.37, 2.53],P 0.000 1;OR=2.67,95 % CI[1.93,3.70],P 0.000 01）. In terms of safety,compared with chemotherapy alone,treatment of NSCLC patients with method of reinforcing earth to strengthen metal plus chemotherapy is asscociated with lower incidence rate of grade 3-4 white blood cells decline,digestive tract reactions and liver function damage（OR=0.38,95 % CI[0.24,0.61],P 0.000 1;OR=0.38,95 % CI[0.19,0.77],P = 0.007; OR=0.16, 95 % CI [0.05, 0.55], P = 0.004）. However, there was no significant effect of method of reinforcing earth to strengthen metal plus chemotherapy on hemoglobin toxicity or platelet toxicity（OR=0.60,95 % CI[0.26,1.36],P = 0.22;OR=0.53,95 % CI[0.29,0.97],P = 0.04）. Conclusion Based on the present analysis,the efficacy of reinforcing earth to strengthen metal plus chemotherapy was superior to chemotherapy alone,producing a significant benefit in white blood cells decline, digestive tract reactions and liver function damage. As the limited quantity of this current study and the evidence with limited strength, further prospective controlled, multi-centric clinical studies with a large sample size are needed to confirm these data.