不同药物联合伽玛刀用于非小细胞肺癌术后患者疗效与不良反应meta分析

Meta-analysis of the efficacy and adverse reactions of different drugs combined with gamma knife in the treatment of non-small cell lung cancer

目的系统评价不同药物联合伽玛刀治疗非小细胞肺癌(NSCLC)术后患者的疗效与不良反应的差异,为临床用药提供循证参考。方法计算机检索Cochrane图书馆、PubMed、中国知网数据库、万方数据库、中文科技期刊数据库,收集不同药物联合伽玛刀治疗(试验组)对比单纯伽玛刀治疗(对照组)用于NSCLC术后患者的随机对照试验(RCT)。筛选文献,采用Stata 16.0软件、RevMan 5.3软件进行meta分析。结果14篇RCT文献纳入研究,包含1059例患者(试验组485例,对照组574例),共涉及10种药物联合伽玛刀干预措施。meta分析结果显示:试验组的近期疗效优于对照组,差异有统计学意义[RR(95%CI):1.19(1.10~1.30),P<0.0001],其中,伽玛刀配合小牛血清去蛋白注射液、血府逐瘀汤加味的治疗的RR值最高,效果最好。试验组和对照组发生胃肠道反应和骨髓抑制反应病例数的差异均无统计学意义[RR(95%CI):0.79(0.46~1.35),P=0.39;RR(95%CI):0.89(0.59~1.36),P=0.60],其中伽玛刀配合中医养阴清肺解毒法辨证施治减轻胃肠道反应的效果显著,RR值最低;伽玛刀配合康莱特治疗的骨髓抑制反应较轻。结论小牛血清去蛋白注射液、血府逐瘀汤加味联合伽玛刀治疗NSCLC术后患者较为安全有效,能够增强近期疗效;中医养阴清肺解毒法辨证施治、康莱特配合伽玛刀治疗方案可以较好地提高患者的生活质量,减少不良反应,具有临床应用价值。

Objective To systematically evaluate the differences between the efficacy and toxic and side effects of different drugs combined with gamma knife in the treatment of non-small cell lung cancer(NSCLC),and provide evidence-based reference for clinical medication.Methods Literatures review on different drugs combined with gamma knife treatment(test group)versus simple gamma knife treatment(control group)for NSCLC postoperative randomized controlled trial(RCT)was done based on Cochrane Library,PubMed,CNKI,Wanfang Database,and Chinese Science and Technology Periodical Database.Stata 16.0 software and RevMan 5.3 software was used for meta analysis.Results Compared with the control group,the experimental group significantly improved the short-term efficacy,the difference was statistically significant,RR=1.19,95%CI(1.10-1.30),P<0.0001.Among all cases,the treatment of gamma knife combined with calf serum deproteinized injection and Xuefu Zhuyu decoction had the highest RR values,which were 2.17(0.97-4.86)and 2.17(0.95-4.94)respectively.There was no significant difference in the number of patients with gastrointestinal and myelosuppressive reactions between the experimental group and the control group[RR(95%CI):0.79(0.46-1.35),P=0.39;RR(95%CI):0.89(0.59-1.36),P=0.60].Among all cases,the treatment of gamma knife combined with traditional Chinese medicine to Yangyin Qingfei has obvious effect on reducing gastrointestinal adverse reactions,with the lowest RR value of 0.19(0.02-1.56).Also,gamma knife and Kanglaite have the best effect of reducing bone marrow suppression reaction,with RR value of 0.27(0.10-0.74).Conclusions Calf serum deproteinized injection,Xuefu Zhuyu Tang Jiawei combined with gamma knife is safer and more effective in the treatment of NSCLC,which can enhance the short-term efficacy;traditional Chinese medicine Yangyin Qingfei detoxification method syndrome differentiation treatment,Kanglaite combined with gamma knife treatment can improve the quality of life of patients and reduce the adverse reactions of patients,and has clinical application value.