复方阿胶浆防治癌症化疗后骨髓抑制疗效和安全性的系统评价
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摘要
[目的]系统评价复方阿胶浆联合化疗防治癌症化疗后骨髓抑制的有效性和安全性。[方法]计算机检索CNKI、WanFang、SinoMed、PubMed、EMbase、The Cochrane Library,搜集关于复方阿胶浆联合常规化疗治疗癌症/肿瘤患者的随机对照试验,检索时限从建库至2017年3月。由2位作者独立筛选文献、提取资料,采用RevMan 5.3软件进行Meta分析。[结果]共纳入17个RCT,包含7个结局指标,1 139例患者。Meta分析结果显示,与单纯化疗组相比,联用复方阿胶浆组在改善外周血象白细胞[MD=-0.71,95%CI (-1.14,-0.28),P=0.001;OR=0.24,95%CI(0.13,0.48),P<0.0001]、血红蛋白[MD=-10.34,95%CI(-15.10,-5.58),P<0.001;OR=0.28,95%CI(0.14,0.54),P=0.000 2]、血小板[MD=-20.94,95%CI(-35.63,-6.25),P=0.005]、红细胞[MD=-0.46,95%CI(-0.69,-0.23),P<0.000 1]及生活质量[OR=3.84,95%CI (2.07,7.11),P<0.000 1]方面差异有统计学意义;对降低血小板所致骨髓毒性[OR=0.58,95%CI(0.27,1.21),P=0.15]、保护中性粒细胞[MD=-0.10,95%CI(-0.66,0.47),P=0.73]及不良反应等方面差异均无统计学意义。[结论]当前证据提示复方阿胶浆联合化疗能够改善癌症化疗后外周血象和生活质量,且安全性较好。但由于纳入文献质量不高,尚需严格设计的高质量临床研究进一步验证。
[Objective] To systematically evaluate the efficacy and safety of combination of chemotherapy and compound Ejiao Jiang for bone marrow suppression after cancer chemotherapy. [Methods] We searched databases to collect RCTs of compound Ejiao Jiang combined with chemotherapy from inception to March 2017. Two researchers independently screened literature,extracted data and evaluated the risk of bias,and did Meta-analysis by RevMan 5.3. [Results] A total of 17 RCTs,involving 7 outcomes and 1 139 patients were included. The results of Meta-analysis showed that:compared with the chemotherapeutic group,compound Ejiao Jiang group had a higher count of white blood cell [MD=-0.71,95%CI(-1.14,-0.28),P =0.001;OR =0.24,95% CI(0.13,0.48),P <0.000 1],hemoglobin[MD=-10.34,95%CI(-15.10,-5.58),P<0.001;OR=0.28,95%CI(0.14,0.54) 0.000 2],blood platelet [MD=-20.94,95%CI(-35.63,-6.25),P=0.005],red blood cell [MD=-0.46,95%CI(-0.69,-0.23),P<0.000 1](OR=3.88,95%CI(2.07,7.11),P<0.000 1] and life quality [OR=3.84,95%CI(2.07,7.11),P<0.000 1],with statistical significance;while had no statistical significance in lower count of bone marrow toxicity owing to blood platelet [OR=0.58,95%CI(0.27,1.21),P=0.15],neutrophils [MD=-0.10,95%CI(-0.66,0.47),P=0.73] and adverse reactions. [Conclusions] The current evidence shows that chemotherapy compound Ejiao Jiang is better to improve the peripheral hemogram and life quality after chemotherapy and is safety. However,due to the limited quality of included researches,conclusions still need to be verified by high quality researches with better design.
[Objective] To systematically evaluate the efficacy and safety of combination of chemotherapy and compound Ejiao Jiang for bone marrow suppression after cancer chemotherapy. [Methods] We searched databases to collect RCTs of compound Ejiao Jiang combined with chemotherapy from inception to March 2017. Two researchers independently screened literature,extracted data and evaluated the risk of bias,and did Meta-analysis by RevMan 5.3. [Results] A total of 17 RCTs,involving 7 outcomes and 1 139 patients were included. The results of Meta-analysis showed that:compared with the chemotherapeutic group,compound Ejiao Jiang group had a higher count of white blood cell [MD=-0.71,95%CI(-1.14,-0.28),P =0.001;OR =0.24,95% CI(0.13,0.48),P <0.000 1],hemoglobin[MD=-10.34,95%CI(-15.10,-5.58),P<0.001;OR=0.28,95%CI(0.14,0.54) 0.000 2],blood platelet [MD=-20.94,95%CI(-35.63,-6.25),P=0.005],red blood cell [MD=-0.46,95%CI(-0.69,-0.23),P<0.000 1](OR=3.88,95%CI(2.07,7.11),P<0.000 1] and life quality [OR=3.84,95%CI(2.07,7.11),P<0.000 1],with statistical significance;while had no statistical significance in lower count of bone marrow toxicity owing to blood platelet [OR=0.58,95%CI(0.27,1.21),P=0.15],neutrophils [MD=-0.10,95%CI(-0.66,0.47),P=0.73] and adverse reactions. [Conclusions] The current evidence shows that chemotherapy compound Ejiao Jiang is better to improve the peripheral hemogram and life quality after chemotherapy and is safety. However,due to the limited quality of included researches,conclusions still need to be verified by high quality researches with better design.
引文
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[13]刘展华,史建文.复方阿胶浆对肺癌化疗增效减毒作用的临床观察[J].中华中医药学刊,2007,25(11):2427-2428.
[14]龙德,谭秦湘,梁瑞梅,等.复方阿胶浆在恶性肿瘤化疗中的作用.规范治疗与科学评价[A].第五届国际中医、中西医结合肿瘤学术交流大会暨第十四届全国中西医结合肿瘤学术大会[C].广州,2014.
[15]邵玉英,刘培民.复方阿胶浆对乳腺癌患者化疗后骨髓保护作用的临床观察[J].中国医药导报,2009,6(28):161-164.
[16]沈旭波,谢国群,高峰,等.复方阿胶浆预防化疗患者血细胞下降的效果观察[J].浙江临床医学,2016,18(11):2062-2063.
[17]宋腾,梁绍平,王华庆,等.复方阿胶浆改善化疗后骨髓抑制的临床疗效观察[J].天津医科大学学报,2016,22(1):24-27.
[18]谭秦湘,龙德,周明强.复方阿胶浆在肿瘤患者化疗中的应用[J].现代中西医结合杂志,2009,18(36):4502-4503.
[19]张荻,侯丽,孙韬,等.复方阿胶浆改善化疗相关性贫血的临床研究[J].北京中医药大学学报(中医临床版),2012,19(3):17-18.
[20]张宇航,李要轩,李雁.复方阿胶浆对恶性肿瘤化疗后白细胞减少症的临床观察[J].中国当代医药,2010,17(12):75-77.
[21]赵井苓.复方阿胶浆联合化疗治疗中晚期妇科肿瘤30例[A].第十一次全国中医妇科学术大会[C].郑州,2011.
[22]周勇.复方阿胶浆预防化疗所致血象下降的有效性[D].济南:山东大学,2013.
[2]曾磊,王国平.中国癌症流行病学与防治研究现状[J].世界最新医学信息文摘,2016,16(87):36-37.
[3]范奎,代良敏,伍振峰,等.放化疗所致骨髓抑制的研究进展[J].中华中医药杂志,2017,32(1):210-214.
[4]田兆兴,杨倩.中医药防治肿瘤放化疗后骨髓抑制的应用及研究进展[J].中国医院药学杂志,2017,37(2):190-193.
[5]朱海芳,海娟,张路,等.复方阿胶浆药理作用研究进展[J].中国药物评价,2013,2(3):135-137.
[6]顾雨芳,张映城,施俊,等.复方阿胶浆防治胃癌患者化疗后白细胞减少的临床观察[J].环球中医药,2012,5(8):614-616.
[7]何佩珊.复方阿胶浆治疗肿瘤化疗相关性贫血临床研究[D].北京:北京中医药大学,2010.
[8]胡家柱,谭洁霞,韩建军,等.复方阿胶浆治疗化疗周期血红蛋白降低的临床观察[J].国际医药卫生导报,2012,18(13):1897-1899.
[9]黄忠华,姜亚莉,韩芳,等.复方阿胶浆预防化疗所致血象下降的效果观察[J].临床合理用药,2016,9(9):5-6.
[10]姜虹,高勇,张雪梅,等.复方阿胶浆对不同疾病化疗患者外周血象的稳定作用[J].国际中医中药杂志,2013,35(4):316-318.
[11]李潇,贾玫,侯丽,等.复方阿胶浆对胃肠道肿瘤化疗相关性贫血患者血清EPO浓度水平影响的临床观察[A].中华中医药学会第二届岐黄论坛--血液病中医药防治分论坛[C].北京,2014.
[12]刘平.复方阿胶浆治疗贫血的临床疗效评价[J].母婴世界,2015,15(2):143-143.
[13]刘展华,史建文.复方阿胶浆对肺癌化疗增效减毒作用的临床观察[J].中华中医药学刊,2007,25(11):2427-2428.
[14]龙德,谭秦湘,梁瑞梅,等.复方阿胶浆在恶性肿瘤化疗中的作用.规范治疗与科学评价[A].第五届国际中医、中西医结合肿瘤学术交流大会暨第十四届全国中西医结合肿瘤学术大会[C].广州,2014.
[15]邵玉英,刘培民.复方阿胶浆对乳腺癌患者化疗后骨髓保护作用的临床观察[J].中国医药导报,2009,6(28):161-164.
[16]沈旭波,谢国群,高峰,等.复方阿胶浆预防化疗患者血细胞下降的效果观察[J].浙江临床医学,2016,18(11):2062-2063.
[17]宋腾,梁绍平,王华庆,等.复方阿胶浆改善化疗后骨髓抑制的临床疗效观察[J].天津医科大学学报,2016,22(1):24-27.
[18]谭秦湘,龙德,周明强.复方阿胶浆在肿瘤患者化疗中的应用[J].现代中西医结合杂志,2009,18(36):4502-4503.
[19]张荻,侯丽,孙韬,等.复方阿胶浆改善化疗相关性贫血的临床研究[J].北京中医药大学学报(中医临床版),2012,19(3):17-18.
[20]张宇航,李要轩,李雁.复方阿胶浆对恶性肿瘤化疗后白细胞减少症的临床观察[J].中国当代医药,2010,17(12):75-77.
[21]赵井苓.复方阿胶浆联合化疗治疗中晚期妇科肿瘤30例[A].第十一次全国中医妇科学术大会[C].郑州,2011.
[22]周勇.复方阿胶浆预防化疗所致血象下降的有效性[D].济南:山东大学,2013.