中医益气健脾解毒法辅助治疗原发性肝癌的荟萃分析

Meta-analysis of Therapy of Replenishing Qi,Invigorating Spleen and Removing Toxicity in the treatment of Primary Liver Cancer

目的通过荟萃分析(Meta分析)评价中医益气健脾解毒法辅助西医常规疗法治疗原发性肝癌的效果。方法检索中国知网、万方、维普、SinoMed、PubMed、EMBASE、考克兰图书馆数据库(截止至2021年3月),筛选符合纳入标准的随机对照试验(Randomized Controlled Trial,RCT)。依据考克兰手册偏倚风险评估工具进行质量评价,提取有效数据后采用Review Manager 5.3进行Meta分析。结果最终纳入21篇文献,包括1760例肝癌患者,文献整体质量偏低,荟萃分析结果显示益气健脾解毒法辅助西医常规疗法能提高6个月生存率[OR=3.91,95%CI(2.37,6.44),P<0.001]、1年生存率[OR=3.40,95%CI(2.46,4.69),P<0.001];提高生活质量(KPS评分)改善率[OR=2.78,95%CI(1.80,4.30),P<0.001];提高WHO标准有效率[OR=1.71,95%CI(1.25,2.33),P<0.001]、RECIST标准有效率[OR=1.67,95%CI(1.08,2.57),P=0.02]。此外,益气健脾解毒法辅助西医常规疗法可改善肝癌患者的免疫功能。漏斗图显示存在发表偏倚可能。结论中医益气健脾解毒法辅助西医疗法治疗肝癌优于单用西医疗法。由于相关文献质量偏低,未来需要更多的高质量RCT来提高相关研究的质量。

Objective To evaluate the efficacy of traditional Chinese medicine(TCM)therapy of replenishing qi,invigorating spleen and removing toxicity in the treatment of primary liver cancer by using meta-analysis.Methods Databases of CNKI,Wanfang,VIP,SinoMed,Pubmed,Embase,and Cochrane Library were retrieved,and the search was updated in March 2021.The randomized controlled trials(RCTs)that met the inclusion criteria were screened out.The quality of the included trials was evaluated according to the Cochrane risk of bias assessment tool.After extracting the data of included literatures,Review Manager 5.3 was employed for meta-analysis of the extracted data.Results Totally 21 RCTs were finally included,involving 1760 patients,and the overall quality of studies was not high.The results of meta-analysis showed that TCM therapy of replenishing qi,invigorating spleen and removing toxicity combined with conventional western medicine therapy could improve 6-month survival rate[OR=3.91,95%CI(2.37,6.44),P<0.001],one-year survival rate[OR=3.40,95%CI(2.46,4.69),P<0.001],increase the rate for improving the quality of life[OR=2.78,95%CI(1.80,4.30),P<0.001],and enhance the efficiency evaluated with WHO standard[OR=1.71,95%CI(1.25,2.33),P<0.001]and the efficiency evaluated with RECIST standard[OR=1.67,95%CI(1.08,2.57),P=0.02].Besides,TCM therapy of replenishing qi,invigorating spleen and removing toxicity combined with routine western medicine could improve the immune function of patients with liver cancer.Funnel plots showed that publication bias of the studies might exist.Conclusion TCM therapy of replenishing qi,invigorating spleen and removing toxicity combined with routine western medicine exerts stronger effect for the treatment of liver cancer than western medicine alone.However,due to the relatively low quality of the included studies,high-quality RCTs are still needed to perform in the future.