注射用黄芪多糖辅助治疗非小细胞肺癌的Meta分析

A Meta-analysis of astragalan injection as adjunctive therapy for non-small-cell lung cancer

目的系统评价注射用黄芪多糖联合放疗、化疗作为非小细胞肺癌(NSCLC)辅助治疗的有效性和安全性。方法计算机检索截止到2017年4月中国知网(CNKI)、中国科技期刊全文数据库(VIP)、万方数据库、PubMed、Cochrane图书馆和EMbase数据库,收集有关黄芪多糖联合放疗、化疗治疗NSCLC的随机对照试验,按照Cochrane干预措施系统评价手册5.1.0评价标准对纳入的研究进行质量评价,并用Rev Man 5.3.5软件进行Meta分析。结果最终共纳入9个RCT,共783例患者。Meta分析结果显示:治疗组在治疗有效率[OR=1.93,95%CI(1.24,3.00),P=0.003]、卡氏评分[MD=9.33,95%CI(7.26,11.40),P<0.000 01]、CD_3^+[MD=11.26,95%CI(10.40,12.11),P<0.000 01]、CD_4^+[MD=10.51,95%CI(7.64,13.39),P<0.000 01]、CD_4^+/CD_8^+[MD=0.39,95%CI(0.32,0.46),P<0.000 01]、白细胞计数[MD=1.81,95%CI(1.49,2.13),P<0.000 01]、中性粒细胞计数[MD=2.23,95%CI(1.84,2.61),P<0.000 01]等方面均优于对照组。然而,仅有1篇研究报道不良事件。结论注射用黄芪多糖联合放疗、化疗能提高非小细胞肺癌疗效,减少放疗化疗后不良反应的发生。但是由于此研究纳入文献数量过少且质量不高,上述结论尚需要更多的大样本高质量多中心大型RCT予以证实。

Objective To systematically evaluate the efficacy and safety of astragalan injection as adjunctive therapy for non-small-cell lung cancer（NSCLC）along with radiotherapy or chemotherapy.Methods All randomized controlled trials（RCTs）on treatments of astragalan injection for NSCLC were searched from the main medical databases,including CNKI Database,Wang Fang Database,VIP Database,Pub Med Database,Cochrane library,and Embase Database until April,2017.According to the 5.1.0 evaluation standard of Cochrane intervention systematic evaluation manual,the quality evaluation of the included research is carried out,and meta analysis is carried out with Rev Man 5.3.5 software.Results Totally nine studies were included,involving 783 cases.Meta-analysis results indicated that treatment group showed better results compared with controlled group,concerning total effective rate（OR = 1.93,95%CI[1.24,3.00],P = 0.003）,KPS score（MD = 9.33,95%CI[7.26,11.40],P〈0.000 01）,CD3~＋（MD = 11.26,95%CI[10.40,12.11],P〈0.000 01）,CD4^＋（MD = 10.51,95%CI[7.64,13.39],P〈0.000 01）,CD4^＋/CD8^＋（MD = 0.39,95%CI[0.32,0.46],P〈0.000 01）,WBC（MD = 1.81,95%CI[1.49,2.13],P〈0.000 0 1）,Neutrophilic granulocyte（MD = 2.23,95%CI[1.84,2.61],P〈0.000 01）.However,only one study reported the adverse events.Conclusion Astragalan injection combined with radiotherapy or chemotherapy may improve the therapeutic effect for NSCLC,meanwhile reduce side effects of radiotherapy and chemotherapy.However,more multiple-center and large-sample RCTs with higher quality are required to confi rm the results.