胸腺肽联合奥沙利铂胸腔灌注治疗肺癌合并恶性胸腔积液的Meta分析
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摘要
目的:系统评价胸腺肽联合奥沙利铂胸腔灌注治疗肺癌合并恶性胸腔积液(MPE)的安全性与疗效。方法:计算机检索中国知网数据库(CNKI)、维普数据库(VIP)、万方数据库(WANGFANG)、Springer Link、PubMed,同时辅以手工检索,收集自建库至2018年5月胸腺肽联合奥沙利铂胸腔灌注化疗(试验组)与奥沙利铂单药胸腔灌注(对照组)治疗肺癌合并MPE的随机对照研究(RCT)。使用Cochrane系统评价指导手册5.0评价纳入的RCT质量,采用RevMan5.3软件进行Meta分析,结局指标为胸腔积液控制有效率、临床获益率、血清免疫指标、胸腔积液炎症指标及不良反应发生率。结果:本研究共纳入8项RCT,共328例患者。Meta分析结果显示,试验组的胸腔积液控制有效率优于对照组(RR=1.36,95%CI:1.24～1.48,P<0.000 01),临床获益率优于对照组(RR=1.34,95%CI:1.17～1.53,P<0.000 1);试验组血清免疫指标较对照组升高,胸腔积液炎症指标较对照组降低,差异均有统计学意义(均P<0.05);试验组不良反应发生率低于对照组(P<0.05)。结论:胸腺肽联合奥沙利铂胸腔灌注治疗肺癌合并MPE在控制胸腔积液、提高机体免疫力、减少局部炎症反应及不良反应方面均优于单独应用奥沙利铂。
Objective:To evaluate the effectiveness and safety of the combination of thymosin and oxaliplatin perfusion chemotherapy and oxaliplatin alone in the treatment of lung cancer complicated with malignant pleural effusion.Methods:Databases of CNKI,WANGFANG,VIP,PubMed and Springer Link were searched to collect the randomized controlled trials(RCT)on thymosin plus oxaliplatin versus oxaliplatin alone in the treatment of lung cancer accompany with malignant pleural effusion from inception to May2017.The quality of RCTs was assessed by Cochrane handbook 5.0 and meta-analysis was carried out by RevMan 5.3 software.Results:A total of 8 RCTs,which involved 328 patients,were enrolled.Meta-analysis showed that thymosin combined with oxaliplatin significantly improved the control of the malignant pleural effusions(RR=1.36,95%CI:1.24-1.48,P<0.000 01)and optimized clinical benefit(RR=1.34,95%CI:1.17-1.53,P<0.000 1).Compared to oxaliplatin treatment alone,the combination of thymosin and oxaliplatin resulted in higher levels of serum immune indexes while lower inflammatory factors levels in pleural effusion and the incidence of adverse reactions(P<0.05).Conclusion:Thymosin combined with oxaliplatin perfusion chemotherapy was more effective than oxaliplatin treatment alone for lung cancer complicated with malignant pleural effusion.It could improve the control of the malignant pleural effusions and body immunity,reduce local inflammatory response and the incidence of adverse reactions.
Objective:To evaluate the effectiveness and safety of the combination of thymosin and oxaliplatin perfusion chemotherapy and oxaliplatin alone in the treatment of lung cancer complicated with malignant pleural effusion.Methods:Databases of CNKI,WANGFANG,VIP,PubMed and Springer Link were searched to collect the randomized controlled trials(RCT)on thymosin plus oxaliplatin versus oxaliplatin alone in the treatment of lung cancer accompany with malignant pleural effusion from inception to May2017.The quality of RCTs was assessed by Cochrane handbook 5.0 and meta-analysis was carried out by RevMan 5.3 software.Results:A total of 8 RCTs,which involved 328 patients,were enrolled.Meta-analysis showed that thymosin combined with oxaliplatin significantly improved the control of the malignant pleural effusions(RR=1.36,95%CI:1.24-1.48,P<0.000 01)and optimized clinical benefit(RR=1.34,95%CI:1.17-1.53,P<0.000 1).Compared to oxaliplatin treatment alone,the combination of thymosin and oxaliplatin resulted in higher levels of serum immune indexes while lower inflammatory factors levels in pleural effusion and the incidence of adverse reactions(P<0.05).Conclusion:Thymosin combined with oxaliplatin perfusion chemotherapy was more effective than oxaliplatin treatment alone for lung cancer complicated with malignant pleural effusion.It could improve the control of the malignant pleural effusions and body immunity,reduce local inflammatory response and the incidence of adverse reactions.
引文
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[18]吕希俊,邓海英,周凡,等.奥沙利铂联合胸腺肽治疗肺癌恶性胸腔积液的临床疗效[J].肿瘤药学,2018,8(1):77-83.
[19]HU CY,ZHANG YH,WANG T,et al.IL-2reverses CD8(+)T cell exhaustion in clinical malignant pleural effusion of lung cancer[J].Clinical&Experimental Immunology,2016,186(1):106-114.
[20]GHAYUMI M A,MOJTAHEDI Z,FATTAHI M J.Th1and Th2cytokine profiles in malignant pleural effusion[J].Iranian Journal of Immunology,2011,8(4):195.
[21]BROMBERG J,WANG T C.Inflammation and cancer:IL-6and STAT3complete the link[J].Cancer Cell,2009,15(2):79-80.
[22]LU C C,KUO H C,WANG F S,et al.Upregulation of TLRs and IL-6as a marker in human colorectal cancer[J].Int J Mol Sci,2014,16(1):159-177.
[23]NAM H S.Malignant pleural effusion:Medical approaches for diagnosis and management[J].Tuberculosis&Respiratory Diseases,2014,76(5):211-217.
[24]MARAZIOTI A,BLACKWELL T S,STATHOPOULOS G T.The lymphatic system in malignant pleural effusion.Drain or immune switch[J].American Journal of Respiratory&Critical Care Medicine,2014,189(6):626-627.
[2] LAURSEN S B,HANSEN J M,ANDERSEN P E,et al.Supplementary arteriel embolization an option in high-risk ulcer bleeding--a randomized study[J].Scandinavian Journal of Gastroenterology,2014,49(1):75.
[3] ANDERSEN P E,DUVNJAK S.Endovascular treatment of nonvariceal acute arterial upper gastrointestinal bleeding[J].World Journal of Radiology,2010,2(7):257-261.
[4]刘粉霞.中心静脉导管在恶性胸腔积液治疗中的应用[J].现代肿瘤医学,2014,22(1):92-94.
[5] RODRIGUEZPANADERO F,MONTESWORBOYS A.Mechanisms of Pleurodesis[J].Respiration,2012,83(2):91-98.
[6] CUNNINGHAM D,STARLING N,RAO S,et al.Capecitabine and oxaliplatin for advanced esophagogastric cancer.[J].N Engl J Med,2008,362(9):858-859.
[7] TESNIERE A,SCHLEMMER F V,KEPP O,et al.Immunogenic death of colon cancer cells treated with oxaliplatin[J].Oncogene,2009,29(4):482-491.
[8] YUAN C,ZHENG Y,ZHANG B,et al.Thymosinα1promotes the activation of myeloid-derived suppressor cells in a Lewis lung cancer model by upregulating Arginase 1[J].Biochemical&Biophysical Research Communications,2015,464(1):249-255.
[9]周涛,刘素勤,刘基巍.肿瘤内科治疗的疗效评价[J].中国医院用药评价与分析,2005,22(4):6-7.
[10]JADAD A R,MOORE R A,CARROLL D,et al.Assessing the quality of reports of randomized clinical trials:is blinding necessary?[J].Controlled Clinical Trials,1996,17(1):1-12.
[11]王正洪,方亮,蒋明东,等.胸腺肽联合奥沙利铂对肺癌恶性胸腔积液患者的疗效和血清炎性因子及T淋巴细胞的影响[J].川北医学院学报,2018,33(1):94-97.
[12]梁锡堂,马国平,高雪平.奥沙利铂联合胸腺肽治疗肺癌恶性胸腔积液临床疗效分析[J].河北医药,2015,37(13):1994-1996.
[13]刘滔,王春茂,文峰,等.奥沙利铂联合胸腺肽胸腔内灌注治疗恶性胸腔积液的疗效及对老年肺癌病人免疫功能的影响[J].实用老年医学,2018,32(3):252-255.
[14]应樱.奥沙利铂联合胸腺肽治疗肺癌合并恶性胸腔积液的疗效[J].中国生化药物杂志,2017,37(12):68-69.
[15]杨明生,任中海.奥沙利铂联合胸腺肽治疗肺癌合并恶性胸腔积液的临床观察[J].中国药房,2016,27(27):3767-3770.
[16]李珍炼.奥沙利铂联合胸腺肽治疗肺癌合并恶性胸腔积液的疗效[J].健康之路,2017(6):13.
[17]周曾,陈珍梅.胸腺肽与奥沙利铂联用对肺癌患者恶性胸腔积液的临床疗效评价[J].抗感染药学,2017,14(9):1794-1796.
[18]吕希俊,邓海英,周凡,等.奥沙利铂联合胸腺肽治疗肺癌恶性胸腔积液的临床疗效[J].肿瘤药学,2018,8(1):77-83.
[19]HU CY,ZHANG YH,WANG T,et al.IL-2reverses CD8(+)T cell exhaustion in clinical malignant pleural effusion of lung cancer[J].Clinical&Experimental Immunology,2016,186(1):106-114.
[20]GHAYUMI M A,MOJTAHEDI Z,FATTAHI M J.Th1and Th2cytokine profiles in malignant pleural effusion[J].Iranian Journal of Immunology,2011,8(4):195.
[21]BROMBERG J,WANG T C.Inflammation and cancer:IL-6and STAT3complete the link[J].Cancer Cell,2009,15(2):79-80.
[22]LU C C,KUO H C,WANG F S,et al.Upregulation of TLRs and IL-6as a marker in human colorectal cancer[J].Int J Mol Sci,2014,16(1):159-177.
[23]NAM H S.Malignant pleural effusion:Medical approaches for diagnosis and management[J].Tuberculosis&Respiratory Diseases,2014,76(5):211-217.
[24]MARAZIOTI A,BLACKWELL T S,STATHOPOULOS G T.The lymphatic system in malignant pleural effusion.Drain or immune switch[J].American Journal of Respiratory&Critical Care Medicine,2014,189(6):626-627.