穴位贴敷治疗乳腺癌化疗后恶心呕吐的Meta分析

Acupuncture application in the management of nausea and vomiting after chemotherapy for breast cancer:a meta-analysis

目的Meta分析穴位贴敷治疗乳腺癌化疗后恶心呕吐的临床疗效。方法检索中国知网(CNKI)、维普数据库(VIP)、中国生物医学文献数据库(CBM)和万方数据库(WAN-FANG DATA)四大数据库,检索时间从数据库建立起至2020年8月12日止,收集采用穴位贴敷法对乳腺癌术后患者进行干预的随机对照试验(RCT)的文献,采用软件Stata SE 15.1进行Meta分析。结果纳入15篇文献,共计1139例乳腺癌化疗术后伴恶心呕吐患者,其中试验组573例,对照组566例。随机效应模型显示,纳入分析的文章异质性较大(I^(2)=56.1%,P=0.01)。经敏感性分析后,删除两篇对结果影响较大的文献,进而采用固定效应模型进行分析。结果显示,与单纯的常规西医治疗相比,加入穴位贴敷法后的治疗方案对缓解恶心呕吐等胃肠道不良反应的效果更为明显,13个研究汇总,差异有统计学意义(RR=1.314,95%CI:1.225-1.408,P=0.51)。提示在西医常规治疗基础上配合穴位贴敷,效果优于单纯西医治疗。漏斗图检验存在发表偏倚,剪补法显示需再补充4篇文献以减少发表偏倚。结论乳腺癌患者化疗术后出现恶心呕吐等不良胃肠道反应,在常规西医治疗基础上配合穴位贴敷治疗,效果较单纯的西医常规治疗好,值得临床推广。

Objective A meta-analysis was conducted to systematically evaluate the clinical efficacy of acupuncture application for nausea and vomiting after chemotherapy for breast cancer.Methods We systematically searched China National Knowledge Infrastructure(CNKI),VIP database,China Biology Medicinedisc(CBM)and WAN-FANG DATA for randomized controlled trials(RCT)on acupuncture application after chemotherapy for breast cancer from inception up to August 12,2020.Meta-analyses were conducted using Stata 15.1.Results A total of 15 studies were included,including 1139 patients with nausea and vomiting after chemotherapy for breast cancer among whom 573 patients were in the experimental group and 566 patients were in the control group.The random effects model showed that heterogeneity exists among studies included in the analysis(I^(2)=56.1%,P=0.01).After sensitivity analysis,two documents that had a great impact on the results were excluded,and a fixed effects model was used for the analysis.The results showed that compared with simple pure conventional western medicine,the addition of acupuncture application therapy is highly effective in relieving gastrointestinal adverse reactions such as nausea and vomiting.Statistically significant differences were discovered in the pooled analysis of the 13 studies(RR=1.314,95%CI 1.225~1.408,P=0.51)suggesting the great significance of acupuncture application added to conventional western medicine treatment compared with single western medicine treatment.Bias exists in the funnel plot analysis,and the cut-and-fill diagrams showed that 4 more studies were needed to reduce publication bias.Conclusion In view of adverse gastrointestinal reactions such as nausea and vomiting after chemotherapy for breast cancer,acupuncture application added to conventional western medical treatment is more effective than conventional western medical treatment alone,and it is worthy of clinical promotion.