5种中成药外治放射性皮炎的网状meta分析

Network meta-analysis of 5 Chinese patent medicines for radiodermatitis

目的应用网状meta分析对5种常用中成药外治放射性皮炎的疗效进行评价。方法计算机检索中国知网(CNKI)、万方(Wanfang)、中国生物医学文献服务系统(SinoMed)、维普(VIP)、PubMed、Cochrane Library、Embase、Web of Science等数据库,搜索有关中成药治疗放射性皮炎的随机对照试验(RCTs)。采用Stata 15.1软件进行网状meta分析。结果最终纳入30项研究,共包含2793例患者,网状meta分析显示,临床总有效率累计概率排序为三黄膏(81.8%)>金黄散(80.6%)>康复新液(71%)>复方紫草油(64.9%)>射线防护剂(56.9%)>湿润烧伤膏(46.1%)>生长因子(27.6%)>抗菌药物(16.5%)>常规护理(4.6%);皮肤损伤愈合时间累计概率排序为康复新液(98%)>抗菌药物(66.1%)>湿润烧伤膏(35.9%)>常规护理(0%);重度皮炎发生率累计概率排序为三黄膏(78.6%)>湿润烧伤膏(57%)>康复新液(56.2%)>医用射线防护剂(51.4%)>常规护理(6.9%);结果提示,与常规护理、抗菌药物和生长因子相比,5种中成药均能改善临床总有效率;与常规护理比较,康复新液和湿润烧伤膏可缩短皮肤损伤愈合时间;在控制重度皮炎发生率方面,三黄膏、湿润烧伤膏和康复新液均优于医用射线防护剂和常规护理。结论5种中成药外治放射性皮炎的临床疗效较常见西医治疗更佳,其中三黄膏的疗效可能更为突出。但鉴于不同治疗措施间纳入的质量、研究数量存在较大差异,本研究中成药的SUCRA累计概率排序需谨慎参考。

Objective To systematically evaluate the efficacy of 5 commonly used Chinese patent medicines for radiodermatitis by network meta-analysis.Methods Randomized controlled trials(RCTs)of commonly used Chinese patent medicines for radiodermatitis were collected via computer retrieval from CNKI,Wanfang,SinoMed,VIP,PubMed,Cochrane Library,Embase,and Web of Science.Network meta-analysis was performed in Stata 15.1.Results Totally 30 RCTs involving 2793 patients wereincluded.The network meta-analysis showed that Sanhuang ointment(81.8%)had the best effect,followed by Jinhuang powder(80.6%),Kangfuxin solution(71%),compound zicao oil(64.9%),medical radiation protective agent(56.9%),MEBO(46.1%),growth factor(27.6%),antibiotic(16.5%),and conventional nursing(4.6%).As for N-terminal healing time of skin injury,Kangfuxin solution(98%)was most effective,followed by antibiotics(66.1%),MEBO(35.9%),and conventional nursing(0%).For incidence of severe dermatitis,Sanhuang ointment(78.6%)was most effective,followed by MEBO(57%),Kangfuxin solution(56.2%),medical radiation protective agent(51.4%),and conventional nursing(6.9%).Compared with conventional nursing,antibiotics and growth factors alone,the 5 Chinese patent medicines improved the total effective rate.Compared with conventional nursing,Kangfuxin solution and MEBO shortened the healing time in skin injury.In controlling the incidence of severe dermatitis,Sanhuang ointment,MEBO and Kangfuxin solution were superior to medical radiation protective agents and conventional nursing.Conclusion The clinical efficacy of 5 Chinese patent medicines for radiodermatitis is better than that of the common western medicine,with Sanhuang ointment the most prominent.However,given the differences in the quality and number of studies included,the ranking of SUCRA cumulative probability of Chinese patent medicines in this study awaits further verification.