中药注射剂联合FOLFOX4化疗方案治疗胃癌的贝叶斯网状meta分析

Bayesian network meta-analysis of traditional Chinese medicine injection combined with FOLFOX4 chemotherapy in gastric cancer treatment

目的:采用贝叶斯网状Meta分析评价8种中药注射剂联合FOLFOX4治疗胃癌(Gastric Cancer,GC)的疗效。方法:检索Pubmed、EMbase、中国生物医学文献数据库(CBM)、维普、万方和中国知网等数据库的中药注射剂联合FOLFOX4治疗GC的随机对照试验(RCTs),按纳入与排除标准筛选,对纳入RCTs做质量评价,采用Stata14.0、WinBugs软件进行数据分析。结果:共纳入8种中药注射剂,24个RCTs共1844例胃癌患者。结果显示:以FOLFOX4化疗方案为共同干预措施,8种中药注射剂在化疗总有效率和患者生存质量、降低恶心呕吐和白细胞减少发生率均有优于单纯化疗的趋势,但仅有部分中药注射剂与单纯化疗方案的差异有统计学意义。不同中药注射剂之间的各项结局指标差异无统计学意义。概率排序显示,在提高化疗总有效率及减少恶心呕吐发生率方面,鸦胆子油乳注射液排第一位;在提高生存质量和白细胞减少发生率方面,复方苦参注射液和华蟾素注射液分别各排第一位。结论:相较于其他5种中药注射剂,鸦胆子油乳注射液、复方苦参注射液及华蟾素注射液成为最优选择的概率最大。

Objective: To evaluate the efficacy of eight traditional Chinese medicine injections combined with FOLFOX4 in the treatment of gastric cancer( Gastric Cancer,GC) by Bayesian network meta-analysis. Methods: Randomized controlled trials( RCTs) of traditional Chinese medicine injections combined with FOLFOX4 in the treatment of GC were performed according to pubmed,EMbase,China Biomedical Literature Database,Weipu Database,Wanfang Database and China Knowledge Network,etc. Quality evaluation was taken by RCTs and data analysis was performed by Stata14. 0 and WinB ugs software. Results: A total of 8 kinds of traditional medicine injections on 1844 patients of24 RCTs was included. The results of network meta-analysis showed that FOLFOX4 chemotherapy as a common intervention,the eight traditional Chinese medicine injections had more advantage than chemotherapy in the total effective rate of chemotherapy,quality of life,and reduction of nausea and vomiting and leukopenia. Significant differences were observed in some traditional medicine injections. Among the 8 kinds of traditional medicine injections,no significant difference was discovered. Probability ranking showed that Brucea javanica oil emulsion was the best choice to increase the total effective rate of chemotherapy and the incidence of nausea and vomiting. Compound Kushen injection and Huachansu injection showed advantage on increasing the quality of life and reducing incidence of leukopenia separately. Conclusion:Compared with other five traditional Chinese medicine injections,Brucea javanica oil emulsion,compound Kushen injection and Huachansu injection show highest probability of being the best choice.