华蟾素治疗癌痛有效性和安全性的系统评价和Meta分析

Systematic review and Meta-analysis of efficacy and safety of Huachansu in treating cancer-related pain

为评价华蟾素治疗癌痛的有效性和安全性。该研究系统全面地检索四大中文数据库(CNKI,VIP,Wan Fang,Sino Med)和三大英文数据库(Cochrane Library,Medline,PubMed)建库至2018年10月,按照预先制定的遴选标准筛选出华蟾素治疗癌痛的随机对照试验(RCTs),采用Rev Man 5. 3软件进行Meta分析。结果共检索出241篇文献,最终纳入10个研究,总样本量为1 293例,试验组648例,对照组645例,所纳入研究总体质量普遍偏低。Meta分析结果显示:华蟾素联合西药止痛药治疗癌痛在近期疼痛缓解效果、提高生活质量和便秘、恶心呕吐、头晕、嗜睡、厌食等不良反应发生方面优于单用西药止痛药,并且具有止痛起效时间短,维持时间长的优势,但不能降低排尿困难的发生率。基于该研究结果,表明华蟾素治疗癌痛有一定的疗效,并且可提高患者生活质量,降低不良反应的发生,未见严重不良反应发生。但由于受到纳入研究数量少,且未对不同剂型进行分层、纳入的研究质量普遍偏低、存在发表性偏倚等诸多局限性,致使该研究结果证据质量较低,故在运用该结论时需谨慎。华蟾素治疗癌痛的有效性和安全性还有待今后开展设计合理、实施严谨、报告规范的,大样本、多中心、随访时间足够的随机对照试验来证实。

To evaluate the effectiveness and safety of Huachansu in the treatment of cancer-related pain,four Chinese databases(CNKI,VIP,Wan Fang,Sino Med)and three English databases(Cochrane Library,Medline,PubMed)were systematically and comprehensively retrieved since the establishment of each database to October 2018.Randomized controlled trials(RCTs)for the treatment of cancer-related pain with Huachansu were screened out according to pre-established inclusion criteria and exclusion criteria.Rev Man5.3 software was used for Meta-analysis.A total of 241 articles were retrieved,and finally 10 studies were included.The total sample size was 1 293,including 648 in the experimental group and 645 in the control group.The overall quality of the included studies was generally low.The results of Meta-analysis showed that Huachansu combined with Western medicine acesodynes was superior to the single use of Western medicine acesodynes in the treatment of short-term pain relief,improvement of quality of life and reduction of constipation,nausea and vomiting,dizziness,drowsiness,anorexia and other adverse reactions.And it also has the advantage of a shorter onset time and longer duration time of analgesia,but cannot reduce the incidence of dysuria.Based on the findings,Huachansu had a certain effect in the treatment of cancer-related pain,and a significant positive effect on the improvement of quality of life and the reduction of adverse reactions.No serious adverse reactions occurred.However,due to the small number of studies included,the low quality of the included studies,published biases and other restrictions,the evidence in this study has a low quality,and the conclusion shall be adopted with caution.The effectiveness and safety of Huachansu in the treatment of cancer-related pain remained to be further confirmed in the future with a well-designed,rigorous,and standardized report,with a large sample size,multiple centers,and sufficient follow-up time for randomized controlled trials.