中药预防顺铂肾毒性的Meta分析
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摘要
目的评估中药对顺铂所致肾毒性的预防疗效。方法检索中外数据库,日期截止到2018年4月,最终用软件RevMan 5.3进行Meta分析。结果获得相关的文献共240篇,纳入21篇符合预订标准的随机对照试验(RCT)。Meta分析结果显示,与对照组比较,中药组可提高总有效率[RR=1.11,95%CI:(1.06,1.17),P<0.05],降低尿素氮(BUN)水平[MD=-0.76,95%CI:(-1.31,-0.21),P<0.05],差异有统计学意义;降低血肌酐(SCr)水平[MD=-19.77,95%CI:(-32.81,-6.73),P<0.05],差异有统计学意义。结论中药的顺铂肾毒性的预防疗效高于对照组,由于此系统评价所纳入文献质量较低,故亟需更多高质量的RCT进一步完善此结论。
Objective To assess the preventive effectiveness of Chinese medicine cisplatin-induced renal toxicity. Methods Chinese and foreign databases were retrieved with the deadline of April 2018. The software for Meta-analysis is RevMan 5.3. Results A total of 240 articles were obtained. 21 studies were identified finally. The results showed that Chinese medicine can improve the total effective rate [RR=1.11, 95% CI:(1.06, 1.17), P<0.05], reduce the value of BUN [MD =-0.76, 95% CI:(-1.31,-0.21), P<0.05[, and reduce the value of SCr [MD =-19.77, 95% CI:(-32.81,-6.73), P<0.05]. Conclusion Chinese medicine has effects in reducing the incidence of cisplatin-induced renal toxicity. RCTs of higher quality are needed because of the low quality of the literature.
Objective To assess the preventive effectiveness of Chinese medicine cisplatin-induced renal toxicity. Methods Chinese and foreign databases were retrieved with the deadline of April 2018. The software for Meta-analysis is RevMan 5.3. Results A total of 240 articles were obtained. 21 studies were identified finally. The results showed that Chinese medicine can improve the total effective rate [RR=1.11, 95% CI:(1.06, 1.17), P<0.05], reduce the value of BUN [MD =-0.76, 95% CI:(-1.31,-0.21), P<0.05[, and reduce the value of SCr [MD =-19.77, 95% CI:(-32.81,-6.73), P<0.05]. Conclusion Chinese medicine has effects in reducing the incidence of cisplatin-induced renal toxicity. RCTs of higher quality are needed because of the low quality of the literature.
引文
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[10]姜华.中西医结合治疗老年晚期非小细胞肺癌疗效观察[J].人民军医,2017,60(1):47-49.
[11]黄敏,郝传铮.益肾清利活血方对顺铂治疗患者肾功能保护作用临床研究[J].中华中医药学刊,2017(9):2446-2449.
[12]李小军,陈东基,冯春兰.同步放化疗联合四君子合沙参麦冬汤治疗局部晚期非小细胞肺癌临床观察[J].甘肃医药,2016,35(4):274-277.
[13]张永红,王玉强,郭全合.中药组方联合化疗治疗中晚期非小细胞肺癌效果观察[J].肿瘤研究与临床,2014,26(5):345-347.
[14]宋燕.五苓散减轻顺铂肾毒性的临床观察[D].济南:山东中医药大学,2013.
[15]苏新华.八珍化积汤联合治疗化疗28例卵巢癌临床观察[J].内蒙古中医药,2013,32(35):76.
[16]徐岗,王远东,邓晓芳,等.参草扶正抗癌冲剂用于晚期非小细胞肺癌化疗的研究[J].现代中西医结合杂志,2011,20(3):261-292.
[17]刘厚颖,李小维,袁戈,等.济生肾气丸加味治疗顺铂化疗后肾毒性36例[J].时珍国医国药,2010,21(8):2091-2092.
[18]黄智芬,刘俊波,黎汉忠,等.参附注射液防治老年恶性肿瘤顺铂肾毒性32例[C].//中国老年学学会老年肿瘤专业委员会年会暨第四届中国老年肿瘤学大会论文集.广西医科大学附属肿瘤医院/广西贵港市中医院,2010:377-379.
[19]杨成雄,周训蓉,李立威,等.虫草洋参胶囊治疗顺铂肾损害临床观察[J].中国医院药学杂志,2007(8):1103-1104.
[20]王缨,葛信国,曹杰,等.益肾排毒法预防顺铂早期肾损害21例[J].陕西中医,2004(4):297-299.
[21]陆素琴.黄芪注射液对顺铂所致肾毒性的防护观察[J].湖北中医杂志,2004(8):12-13.
[22]张晓春.益肾解毒胶囊防治顺铂引起肾毒性的临床研究[J].中国中医药信息杂志,2014,11(11):956-957.
[23]廖开莲,欧阳周,肖华伍,等.黄芪注射液防护顺铂肾毒性79例临床观察[J].医学临床研究,2002(8):461-462.
[24]刘旻,陈军,贾彦焘,等.黄芪注射液对顺铂化疗肾毒性减毒增效作用的临床观察[J].天津中医学院学报,2001,20(4):12-14.
[25]吕真,倪国华,林翼全,等.中药防治老年人顺铂肾毒性31例[J].中国中西医结合杂志,2000,20(5):324.
[26]孔庆志,黄涛,费雁,等.黄芪对大剂量顺铂所致肾毒性防护的临床研究[J].中国肿瘤临床与观察,1999,6(3):9-11.
[27]喻生保,钟文林.中药固肾汤预防顺铂肾毒性[J].宜春医药,1999,(32):8.
[28]全达芳.健脾补肾法预防顺铂为主化疗药所致肾功能损害的临床观察:附167例对照分析[J].广西中医药,1994,17(5):1-5.
[29]程剑华,张所乐,龙浩,等.健脾益气利水汤预防和治疗化疗肾毒性的临床研究[J].中国中西医结合杂志,1994,14(6):331-333.
[30]程剑华,张所乐,黄兆明,等.中药预防和减轻顺铂肾毒性的临床和实验研究[J].实用癌症杂志,1992,7(4):296-299.
[31] Siddik Z H. Cisplatin:mode of cytotoxic action and molecular basis of resistance[J]. Oncogene,2003,22(47):7265-7279.
[32] Pabla N,Dong Z.Cisplatinnephrotoxicity:mechanismsand reno-protective strategies[J].KidneyInt,2008,73(9):994-1007.
[33]孟晓燕,黄向阳.顺铂致急性肾损伤的研究进展[J].医学综述,2014,20(21):3949-3951.
[34]杨红,龚灿,王长虹,等.顺铂化疗联合用药的增效减毒作用研究进展[J].中国药师,2015(5):836-840.
[35]杨慧海,王露露,范超,等.中药有效成分减轻顺铂肾毒性研究进展[J].上海中医药杂志,2017,51(5):98-101.
[36]蒋小燕,葛信国.中药防治顺铂肾损害的研究进展[J].辽宁中医药大学学报,2007(2):62-64.
[37] Vickers A,Goyal N,Harland R,et al. Do certain countries produce only positive results A systematic review of controlledt nials[J]. Control Clin Trials,1998,19(2):159-166.
[2]廖英俊,汤浩,金亚平.抗癌药物顺铂对小鼠的耳、肾和肝毒性及其机制的研究[J].中国药理学通报,2004,20(1):82-85.
[3] AranyI,Safirstein RL.Cisplatinnephrotoxicity[J].Semin Neph-rol,2003,23(5):460-464.
[4]周际昌.实用肿瘤内科学[M].北京:人民卫生出版社,2003:105-115.
[5] Sharma S,Modi A,Narayan G,et al. Protective Effect of Exacum lawii on Cisplatin-induced Oxidative Renal Damage in Rats[J]. Pharmacogn Mag,2018,13(4):S807-S816.
[6] Duffy E A,Fitzgerald W,Boyle K,et al. Nephrotoxicity:Evidence in Patients Receiving Cisplatin Therapy[J]. Clin J Oncol Nurs. 2018,22(2):175-183.
[7] Cao X,Nie X,Xiong S,et al. Renal protective effect of polysulfide in cisplatin-induced nephrotoxicity[J]. Redox Biol,2018,15:513-521.
[8]李淑贞,郭秋红,张再康.中医药抗顺铂肾毒性的研究进展[J].中国药业,2010,19(14):84-85.
[9] Jadad A R,Moore A,Carroll D,et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary[J]. Control Clin Trials,1996,17(1):1.
[10]姜华.中西医结合治疗老年晚期非小细胞肺癌疗效观察[J].人民军医,2017,60(1):47-49.
[11]黄敏,郝传铮.益肾清利活血方对顺铂治疗患者肾功能保护作用临床研究[J].中华中医药学刊,2017(9):2446-2449.
[12]李小军,陈东基,冯春兰.同步放化疗联合四君子合沙参麦冬汤治疗局部晚期非小细胞肺癌临床观察[J].甘肃医药,2016,35(4):274-277.
[13]张永红,王玉强,郭全合.中药组方联合化疗治疗中晚期非小细胞肺癌效果观察[J].肿瘤研究与临床,2014,26(5):345-347.
[14]宋燕.五苓散减轻顺铂肾毒性的临床观察[D].济南:山东中医药大学,2013.
[15]苏新华.八珍化积汤联合治疗化疗28例卵巢癌临床观察[J].内蒙古中医药,2013,32(35):76.
[16]徐岗,王远东,邓晓芳,等.参草扶正抗癌冲剂用于晚期非小细胞肺癌化疗的研究[J].现代中西医结合杂志,2011,20(3):261-292.
[17]刘厚颖,李小维,袁戈,等.济生肾气丸加味治疗顺铂化疗后肾毒性36例[J].时珍国医国药,2010,21(8):2091-2092.
[18]黄智芬,刘俊波,黎汉忠,等.参附注射液防治老年恶性肿瘤顺铂肾毒性32例[C].//中国老年学学会老年肿瘤专业委员会年会暨第四届中国老年肿瘤学大会论文集.广西医科大学附属肿瘤医院/广西贵港市中医院,2010:377-379.
[19]杨成雄,周训蓉,李立威,等.虫草洋参胶囊治疗顺铂肾损害临床观察[J].中国医院药学杂志,2007(8):1103-1104.
[20]王缨,葛信国,曹杰,等.益肾排毒法预防顺铂早期肾损害21例[J].陕西中医,2004(4):297-299.
[21]陆素琴.黄芪注射液对顺铂所致肾毒性的防护观察[J].湖北中医杂志,2004(8):12-13.
[22]张晓春.益肾解毒胶囊防治顺铂引起肾毒性的临床研究[J].中国中医药信息杂志,2014,11(11):956-957.
[23]廖开莲,欧阳周,肖华伍,等.黄芪注射液防护顺铂肾毒性79例临床观察[J].医学临床研究,2002(8):461-462.
[24]刘旻,陈军,贾彦焘,等.黄芪注射液对顺铂化疗肾毒性减毒增效作用的临床观察[J].天津中医学院学报,2001,20(4):12-14.
[25]吕真,倪国华,林翼全,等.中药防治老年人顺铂肾毒性31例[J].中国中西医结合杂志,2000,20(5):324.
[26]孔庆志,黄涛,费雁,等.黄芪对大剂量顺铂所致肾毒性防护的临床研究[J].中国肿瘤临床与观察,1999,6(3):9-11.
[27]喻生保,钟文林.中药固肾汤预防顺铂肾毒性[J].宜春医药,1999,(32):8.
[28]全达芳.健脾补肾法预防顺铂为主化疗药所致肾功能损害的临床观察:附167例对照分析[J].广西中医药,1994,17(5):1-5.
[29]程剑华,张所乐,龙浩,等.健脾益气利水汤预防和治疗化疗肾毒性的临床研究[J].中国中西医结合杂志,1994,14(6):331-333.
[30]程剑华,张所乐,黄兆明,等.中药预防和减轻顺铂肾毒性的临床和实验研究[J].实用癌症杂志,1992,7(4):296-299.
[31] Siddik Z H. Cisplatin:mode of cytotoxic action and molecular basis of resistance[J]. Oncogene,2003,22(47):7265-7279.
[32] Pabla N,Dong Z.Cisplatinnephrotoxicity:mechanismsand reno-protective strategies[J].KidneyInt,2008,73(9):994-1007.
[33]孟晓燕,黄向阳.顺铂致急性肾损伤的研究进展[J].医学综述,2014,20(21):3949-3951.
[34]杨红,龚灿,王长虹,等.顺铂化疗联合用药的增效减毒作用研究进展[J].中国药师,2015(5):836-840.
[35]杨慧海,王露露,范超,等.中药有效成分减轻顺铂肾毒性研究进展[J].上海中医药杂志,2017,51(5):98-101.
[36]蒋小燕,葛信国.中药防治顺铂肾损害的研究进展[J].辽宁中医药大学学报,2007(2):62-64.
[37] Vickers A,Goyal N,Harland R,et al. Do certain countries produce only positive results A systematic review of controlledt nials[J]. Control Clin Trials,1998,19(2):159-166.