中医药治疗结直肠癌临床疗效Meta分析及证型分析

Meta-analysis of Clinical Efficacy of Traditional Chinese Medicine in Treating Colorectal Cancer and Syndrome Analysis

目的评价中医药联合化疗对比单纯化疗对结直肠癌患者生存获益的影响,并总结中医证型分布规律。方法检索中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊数据库,检索范围为1996年1月1日至2016年12月31日,纳入采用辨证论治指导下的中药联合或不联合化疗与单纯化疗进行疗效比较的随机对照临床试验(RCT)及临床观察。采用改良Jadad评分量表进行质量评价,对中位生存时间、疾病控制率、客观缓解率进行Meta分析,并对纳入患者的中医证型分布进行统计。结果共纳入文献84篇,涉及患者8147例。纳入文献质量评价均为0~3分。Meta分析显示,对比单纯化疗患者,中医药联合化疗中位生存时间延长1. 35倍,疾病控制率增加110%,客观缓解率增加78%,差异均有统计学意义(P <0. 001)。患者证型频次分布前5位的分别是脾肾阳虚(1487)、脾虚湿盛(1360)、痰瘀毒聚(639)、气血亏虚(437)、肝郁气滞(301)。结论中医药联合化疗可使结直肠癌患者生存获益,患者中医证型以脾虚为本,多兼有痰、湿、热、瘀、毒等标实。

Objective To evaluate and compare the effects between traditional Chinese medicine（TCM） combined with chemotherapy treatment and chemotherapy treatment on the survival benefit of colorectal cancer patients,and to summarize the distribution pattern of syndromes. Methods The Chinese biomedical literature database,Chinese journal full-text database,Chinese scientific journal database were searched,with the search range from January 1 st,1996 to December 31 st,2016. Randomized controlled clinical trials（RCT） and clinical observations were included to compare the clinical efficacy of TCM combined with or without chemotherapy methods and chemotherapy method under the guidance of syndrome differentiation. The improved Jadad rating scale was used for quality assessment,and meta-analysis was performed on median survival time,disease control rate,and objective remission rate,and the distribution of TCM syndrome in included patients was counted. Results A total of 84 articles with 8147 cases were included in our study. The quality assessment of the included papers was 0-3 points. The results of metaanalysis showed that compared with only given chemotherapy treatment,the median overall survival time of patients received the TCM combined with chemotherapy treatment was 1. 35 times longer,and the disease control rate was enhanced by 110%. The objective remission rate was increased by 78%. The difference was statistically significant（P 〈0. 01）. The top 5 frequency of patients＇ syndromes were deficiency of spleen and kidney yang（1487）,spleen deficiency with dampness（1360）,phlegm stasis with accumulating toxin（639）,qi and blood deficiency（437）,liver depression and qi stagnation（301）. Conclusion Chinese medicine combined with chemotherapy could significantly improve the survival of colorectal cancer patients,and for patients with colorectal cancer,their TCM syndromes are mainly spleen deficiency,and most of which are accompanied with excess syndromes such as phlegm,dampness,heat,stasis and toxin.