中医治疗奥沙利铂化疗诱导神经损伤的Meta分析

Meta-analysis of TCM Treatment of Neurological Injury Induced by Oxaliplatin Chemotherapy

目的评价中医治疗奥沙利铂化疗诱导的神经损伤治疗的临床疗效。方法计算机检索Cochrane Library、美国国立医学图书馆(Pub Med)、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普中文科技期刊数据库(VIP)、万方数据库等数据库,并辅以手动检索,获取关于中医治疗奥沙利铂所致周围神经损伤的临床随机对照研究。按照纳入、排除标准筛选文献,对最终纳入文献进行资料提取和偏倚风险评估。采用Cochrane协作网提供的RevMan 5.3软件进行统计学分析。共纳入20篇中文文献,1544例患者。结果中医治疗有效Meta分析结果显示,中医治疗能明显提高奥沙利铂化疗后神经损伤的治愈率,比常规西药组或者安慰剂/空白组高,两组差异有统计学意义[RR=2.01,95%CI(1.60,2.54),P<0.00001],并且能够降低CIPN发生率[RR=0.75,95%CI(0.68,0.84),P<0.001]及CIPN 2级以上的发生率[RR=0.40,95%CI(0.37,0.48),P<0.001]。结论中医疗法对于奥沙利铂化疗诱导的神经损伤的治愈率、疼痛评分、神经毒性分级的改善明显优于西药或者安慰剂/空白对照组有统计学意义,但尚需更多大样本、严格设计的临床随机对照试验加以验证。

Objective To evaluate the clinical efficacy of TCM treatment of oxaliplatin-induced neurological injury.Methods Chinese Journal Full-text Database(CNKI),VIP Chinese Science and Technology Periodical Database(VIP),Wanfang Database(Wanfang Data),China Biomedical Literature Database(CBM),National Medal(Pub Med)and Cochrane Library database were searched by computer,supplemented by manual retrieval.We obtained a randomized controlled trial of traditional Chinese medicine for the treatment of peripheral nerve injury caused by oxaliplatin.The literature was selected according to the inclusion and exclusion criteria,and the final data was included in the data extraction and risk assessment of bias.Statistical analysis was performed using RevMan 5.3 software provided by the Cochrane Collaboration.A total of 20 Chinese articles and 1544 patients were included.Results The effective Meta-analysis of TCM treatment showed that TCM treatment can significantly improve the cure rate of nerve injury after oxaliplatin chemotherapy,which was higher than that of conventional western medicine group or placebo/blank group.The difference between the two groups was statistically significant[RR=2.01,95%CI(1.60,2.54),P<0.00001],and it can reduce the incidence of CIPN[RR=0.75,95%CI(0.68,0.84),P<0.001].The incidence of CIPN level 2 or higher was significant[RR=0.40,95%CI(0.37,0.48),P<0.001].The improvement of NRS pain score,KPS quality of life score and nerve conduction velocity had a good effect and there was a significant difference(P<0.05).Conclusion The Chinese medical method has a good clinical effect on oxaliplatin-induced neurological injury,but more large-scale,rigorously designed clinical randomized controlled trials are needed to verify.