8种中药注射剂联合顺铂治疗恶性胸腔积液的网状Meta分析

Network meta-analysis of 8 traditional Chinese medicine injections combined with cisplatin for malignant pleural effusion

目的:采用网状Meta分析的方法,比较不同中药注射剂联合顺铂治疗恶性胸腔积液的有效性和安全性。方法:计算机检索EMBASE、PubMed、Cochrane Library、Cancer Lit、中国知网系列数据库、维普中文科技期刊数据库、中国生物医学文献数据库、万方数据库,检索不同中药注射剂联合顺铂治疗恶性胸腔积液的随机对照研究(randomized controlled trial,RCT),按照预先制订的纳入与排除标准筛选文献,并对RCT的质量进行评价,采用ADDIS软件进行分析。结果:共纳入92个RCT,8种中药注射剂(艾迪注射液、复方苦参注射液、华蟾素注射液、康艾注射液、康莱特注射液、参芪扶正注射液、消癌平注射液、鸦胆子油乳注射液),包括5877例患者。网状Meta分析结果显示:在治疗MPE患者的有效率方面,8种中药注射剂联合顺铂方案均比单用顺铂方案有效,概率分布显示消癌平注射液联合顺铂方案成为最佳方案的概率最大(P=0.35)。在改善MPE患者的生活质量方面,艾迪注射液、复方苦参注射液、康艾注射液、鸦胆子油乳注射液联合顺铂方案均比单用顺铂方案有效,概率分布显示康艾注射液联合顺铂方案成为最佳方案的概率最大(P=0.40)。在恶心呕吐方面,艾迪注射液、复方苦参注射液、康莱特注射液、鸦胆子油乳注射液联合顺铂方案均比单用顺铂方案有效,概率分布显示康莱特注射液联合顺铂方案恶心呕吐发生的概率最低(P=0.82)。在白细胞减少方面,艾迪注射液、复方苦参注射液、康艾注射液、康莱特注射液、鸦胆子油乳注射液联合顺铂方案均比单用顺铂方案有效,概率分布显示华蟾素注射液联合顺铂方案白细胞减少发生的可能性最低(P=0.30)。结论:在有效率、生活质量、恶心呕吐、白细胞减少方面,各中药注射剂联合顺铂治疗恶性胸腔积液对比单用顺铂具有优势。概率分布显示,在治疗恶性胸腔积液的有效率方面,消癌平注射液联合顺铂方案为最优方案;在改善生活质量方面,康艾注射液联合顺铂方案为最优方案;在不良反应方面,康莱特注射液联合顺铂方案恶心呕吐发生的概率最低,华蟾素注射液联合顺铂方案白细胞减少的发生概率最低。

OBJECTIVE To assess the clinical effects and safety of traditional Chinese medicine injections(TCMIs)combined with cisplatin(DDP)for malignant pleural effusion(MPE)based on network meta-analysis.METHODS The data on randomized controlled trials(RCTs)of TCMIs combined DDP were searched from EMBASE,PubMed,Cochrane Library,Cancer Lit,CNKI,WanFang database,CBM and VIP Database for Chinese Technical Periodicals.The RCTs were screened according to the predefined inclusion and exclusion criteria,and the quality of RCTs was evaluated and the data were analyzed by ADDIS software.RESULTS A total of 92 RCTs was included,relating to 8 TCMIs(Aidi injection,compound Kushen injection,Huachansu injection,Kang’ai injection,Kanglaite injection,Shenqi Fuzheng injection,Xiaoaiping injection,Brucea Javanica oil emulsion)and 5877 patients.The results of network meta-analysis showed that,the 8 TCMIs combined DDP were more effective than DDP alone for MPE patients,probability ranking results showed that Xiaoaiping injection combined DDP had the biggest probability to become the most effective regime(P=0.35).The Aidi injection,compound Kushen injection,Kang’ai injection and Brucea Javanica oil emulsion combined with DDP were more effective than DDP alone in the aspect of improvement of quality of life,and probability ranking results showed that Kang’ai injection combined with DDP had the biggest probability to become the most effective regime(P=0.40).The Aidi injection,compound Kushen injection,Kanglaite injection,Brucea Javanica oil emulsion combined with DDP were more effective than DDP alone in the aspect of prevention against nausea and vomit,and,probability ranking results showed that Kanglaite injection combined with DDP could reduce the incidences of nausea and vomiting(P=0.82).The Aidi injection,compound Kushen injection,Kang’ai injection,Kanglaite injection and Brucea Javanica oil emulsion combined DDP were more effective than DDP alone in the aspect of decrease of leukopenia,and probability ranking results showed that Huachansu injection combined with DDP could reduce the incidence of leukopenia(P=0.30).CONCLUSION For effectiveness,improvement of life quality and prevention against nausea and vomit and leukopenia,TCMIs combined with DDP have advantages compared to DDP alone.Probability ranking results showed that Xiaoaiping injection combined DDP is the optimal regime in terms of efficiency for treatment of MPE,Kang’ai injection combined with DDP is the most effective in the aspect of improvement of quality of life,Kanglaite injection combined with DDP has the lowest incidence of nausea and vomiting,and Huachansu injection leads to the lowest incidence of leukopenia.