中医药治疗晚期原发性肝癌疗效的Meta分析及原发性肝癌伴门静脉癌栓的中医证候学分析
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摘要
目的：1、运用Meta分析软件对中医药治疗晚期原发性肝癌的疗效进行系统评价；
2、回顾性分析原发性肝癌伴门脉癌栓病人的辩证论证,对其中医辩证分型及常见的用药规律进行总结；
方法：1、运用Meta分析软件系统评价中医药治疗晚期原发性肝癌的疗效,从而对中医药治疗原发性肝癌伴门脉癌栓的疗效进行评价,通过对1999-2008年间发表的中医药治疗晚期原发性肝癌且以现代西医治疗作为对照组的随机对照研究文献的检索,根据入选、剔除标准确定入选论文,对入选文献进行文献质量评价,对文献结局资料进行录取,运用RevMan4.2 (Review Manager)软件进行统计分析,得出Meta分析结果,并进行偏倚及敏感度进行分析。
2、通过对浙江省中医院2003—2009年期间的原发性肝癌伴门静脉癌栓病例收集,根据入选、剔除标准确定入选病例,回顾性的对入选的病例的中医辩证分型、中药治疗(入院首次中药处方)和肝功能的Child分级进行提取,利用加权百分率法进行统计,得出原发性肝癌伴门脉癌栓的常见中医辩证分型和常见的中药运用规律。
结果：1、本次研究共纳入了28篇有关中医药治疗晚期原发性肝癌的随机对照试验,运用Meta分析对中医药治疗晚期原发性肝癌的疗效进行评价：中医治疗组相对于西医对照组,瘤体有效率：相对危险度RR=1.54,95%可信区间(1.34-1.76)、瘤体稳定率：相对危险度RR为=1.58,95%可信区间(1.33-1.87)、生活质量(卡氏评分)稳定率：相对危险度RR为=1.49,95%可信区间(1.34-1.65)、半年生存率：相对危险度RR为=1.66,95%可信区间(1.32-2.09)；分别对四个指标进行总体效应假设检验,P<0.05,都具有统计学意义；
2、对浙江省中医院的原发性肝癌伴门脉癌栓进行回顾性分析,有162份病例入选,运用加权百分率法进行统计,涉及原发性肝癌伴门脉癌栓常见辩证分型依次是：脾虚证、肝郁证、肝郁脾虚证、脾虚湿困证(蕴／组)、气滞证、阴虚证、湿热证、血瘀证、气滞血瘀证等；常用的中药是：茯苓、白术、米仁、猪苓、鸡内金、山药、八月札、蛇舌草、太子参等；涉及的中药种类有：健脾益气、疏肝理气、清热解毒、化湿药、利水渗湿、理气药、活血化瘀等；按照浙江省中医院肝癌中医单病种标准进行分类,常见证型及其中药：脾虚证：(包括脾虚证、脾虚湿困／蕴／组、肝郁脾虚)茯苓、白术、米仁、猪苓、鸡内金、山药、八月札、蛇舌草、太子参等,气滞证：(包括气滞证、肝郁气滞)柴胡、郁金、八月札、白芍、陈皮、猫爪草、川楝子、枳壳、木香等,血瘀证：郁金、丹参、元胡、赤芍、枳壳、莪术、桃仁、红花、三菱、丹皮、川芎、延胡索等,湿热证：(肝胆湿热、湿热证)：柴胡、白芍、茵陈、垂盆草、金钱草、海金沙、黄芩、黄连、黄柏、川朴、苍术等,阴虚证：生地、熟地、红枣、白芍、北沙参、南沙参、枸杞子、麦冬、石斛、五味子、鳖甲、青蒿等。
结论：1、中医药治疗晚期原发性肝癌的疗效进行评价：得出：
1.1中医药治疗组在瘤体有效率方面优于西医对照组,即中医药或中西医结合治疗晚期肝癌在瘤体有效率方面优于西医治疗晚期肝癌；
1.2中医药治疗组在瘤体稳定率方面优于西医对照组,即中医药或中西医结合治疗晚期肝癌在瘤体稳定率方面优于西医治疗晚期肝癌；
1.3中医药治疗组在生活质量(卡氏评分稳定)稳定率方面优于西医对照组,即中医药或中西医结合治疗晚期肝癌在生活质量(卡氏评分稳定)稳定率方面优于西医治疗晚期肝癌。
1.4中医药治疗组在半年生存率方面优于西医对照组,即中医药或中西医结合治疗晚期肝癌在半年生存率方面优于西医治疗晚期肝癌。
2对原发性肝癌伴门静脉癌栓病例进行回顾性分析,得出
2.1常见辩证分型以：脾虚证、肝郁脾虚证、脾虚湿困证最多见,其次是肝郁气滞证、湿热证、阴虚证；
2.2常见中药种类：益气健脾、疏肝理气、化湿药、利水渗湿等；
2.3常见的中药有：茯苓、白术、米仁、猪苓、鸡内金、山药、八月札、蛇舌草、太子参、党参等；
Objective:
1. Using Meta analysis software of traditional Chinese medicine for treatment of advanced hepatocellular carcinoma systematic evaluation.
2. Retrospective analysis of patients with primary liver cancer with portal vein tumor thrombus of dialectical argumentation, its Chinese dialectical classification and summary of the common drug laws.
Methods:
1. Using Meta analysis software system for evaluation of Chinese medicine for treatment of advanced primary liver cancer, which traditional Chinese medicine treatment of hepatocellular carcinoma with portal vein tumor thrombus to evaluate the efficacy. Through the years 1999-2008 published in Chinese medicine for treatment of advanced primary liver cancer and the treatment of modern Western medicine as a control group, randomized controlled study of literature search, According to selected, excluding standard-setting selected papers, selected literature on the quality evaluation of literature, the outcome of the literature data taking, using RevMan4.2 (Review Manager) software for statistical analysis, obtained Meta analysis, and conduct bias and sensitivity to analysis.
2. Through the Chinese medicine hospital in Zhejiang province during the period 2003-2009, primary liver cancer with portal vein tumor thrombus cases of the collection, According to selected, excluding the standard for ascertaining the successful cases, a retrospective of selected cases of dialectical sub-types of TCM, Chinese medicine treatment (hospitalization for the first time a prescription medicine), and liver function in Child classification was extracted, using the weighted percentage method statistics, obtained primary liver cancer with portal vein tumor thrombus in the dialectic of traditional Chinese medicine Chinese medicine sub-type and common use of the law.
Results:
l.This study included a total of 28 about the Chinese medicine for treatment of advanced primary liver cancer randomized controlled trials, the use of Meta analysis of traditional Chinese medicine for treatment of advanced hepatocellular carcinoma evaluated:Chinese medicine treatment group compared to Western medicine control group, Efficient tumor:RR (relative risk)=1.54,95% confidence interval (1.34-1.76), stable tumor rate:RR (relative risk)=1.58,95% confidence interval (1.33-1.87), Quality of life (Karnofsky score) stable rate:RR(relative risk)=1.49,95% confidence interval (1.34-1.65),Half a year survival rate:RR(relative risk)=1.66,95% confidence interval (1.32-2.09); Distribution of the four indicators, the overall effect of hypothesis testing, P<0.05, both statistically significant.
2.Chinese medicine hospital in Zhejiang Province of primary liver cancer with portal vein tumor thrombus were analyzed retrospectively,162 cases were selected, using the weighted percentage method statistics, Primary liver cancer with portal vein tumor thrombus involving the dialectical classification common are:spleen, liver depression, liver depression Spleen, Spleen wet storm (Yun/group), qi stagnation, yin deficiency, damp heat, blood stasis, qi stagnation of blood stasis, etc. Commonly used in traditional Chinese medicine are:Fuling、Baizhu、Miren、Zhuling、Jineijin、Shanyao、Bayuezha、Sheshecao、Taizishe、etc. There are several varieties of Chinese medicine involving:spleen Qi, Shugan Qi, heat detoxification, Huashi drugs, diuresis Shenshi, Qi drugs, blood circulation, etc. Common Syndromes and Chinese Medicine:Spleen Deficiency Syndrome:(including the spleen deficiency syndrome, spleen deficiency wet storm/Yun/group, Liver depression and spleen) Fuling、Baizhu、Miren、Zhuling、Jineijin、Shanyao、Bayuezha、Sheshecao、Taizishen, etc. Qi stagnation: (including air stagnation, qi stagnation) Chaihu、Yujin、Bayuezha、Baoshao、Chenpi、Maozhuacao、Chuanlianzi、Zhike、Muxiang、etc. Blood stasis:Yujin、Danshen、Yuanhu、Chishao、Zhiqiao、Ezhu、Taoren、Honghua、Shanling、Danpi、Chuanxiong、Yanhusuo etc. Damp-heat:(liver and gallbladder damp-heat, damp-heat syndrome): Chaihu、Baishao、Yinchen、Chuipencao、Jinqiancao、Haijinsha、Huangjin、Huanglian、Huangbo、Chuanpu、Cangzhu、etc. Yin deficiency:Shengdi、Shudi、Hongzao、Baishao、Beishashen、Nanshashen、Gouqizi、Maidong、Shihu、Wuweizi、Biejia、Qinghao, and so on.
Conclusion:
1. Chinese medicine treatment of advanced hepatocellular carcinoma evaluated: drawn:
1.1 Chinese medicine treatment group was superior to Western medicine effective tumor control group, that is, combination of Chinese medicine or TCM treatment of advanced liver cancer tumors and efficient in the treatment of advanced liver cancer was superior to Western medicine;
1.2 Chinese medicine treatment group stability and the rate of tumor control group was superior to Western medicine, namely, Chinese medicine or TCM treatment of advanced hepatocellular carcinoma with a stable rate in the tumor is superior to Western medicine for treatment of advanced liver cancer;
1.3 Chinese medicine treatment group quality of life (Karnofsky score stability) and stability rates of the control group was superior to Western medicine, namely, Chinese medicine or combination of Chinese and Western medicine for treatment of advanced liver cancer in the quality of life (Karnofsky score stability) is superior to Western medical treatment of stable rates advanced liver cancer.
1.4Chinese medicine treatment group survival rate was superior to Western medicine in six months the control group, that is, combination of Chinese medicine or TCM treatment of advanced liver cancer survival rate in six months is superior to Western medicine for treatment of advanced liver cancer.
2 Pairs of primary hepatocellular carcinoma with portal vein tumor thrombus retrospectively analyzed with
2.1 Common Syndromes to:Spleen Deficiency Syndrome, Liver depression and spleen deficiency, spleen deficiency wet storm most common, followed by the liver Qi stagnation, Damp-heat, yin deficiency syndrome;
2.2 Common types of traditional Chinese medicine:Qi and spleen, Shugan qi, dampness drugs, diuresis. Shenshi and so on;
2.3 Common traditional Chinese medicine are:Fuling、Baizhu、Miren、Zhuling、Jineijin、Shanyao、Bayuezha、Sheshecao、Taizishen、Dangshen etc.
2、回顾性分析原发性肝癌伴门脉癌栓病人的辩证论证,对其中医辩证分型及常见的用药规律进行总结；
方法：1、运用Meta分析软件系统评价中医药治疗晚期原发性肝癌的疗效,从而对中医药治疗原发性肝癌伴门脉癌栓的疗效进行评价,通过对1999-2008年间发表的中医药治疗晚期原发性肝癌且以现代西医治疗作为对照组的随机对照研究文献的检索,根据入选、剔除标准确定入选论文,对入选文献进行文献质量评价,对文献结局资料进行录取,运用RevMan4.2 (Review Manager)软件进行统计分析,得出Meta分析结果,并进行偏倚及敏感度进行分析。
2、通过对浙江省中医院2003—2009年期间的原发性肝癌伴门静脉癌栓病例收集,根据入选、剔除标准确定入选病例,回顾性的对入选的病例的中医辩证分型、中药治疗(入院首次中药处方)和肝功能的Child分级进行提取,利用加权百分率法进行统计,得出原发性肝癌伴门脉癌栓的常见中医辩证分型和常见的中药运用规律。
结果：1、本次研究共纳入了28篇有关中医药治疗晚期原发性肝癌的随机对照试验,运用Meta分析对中医药治疗晚期原发性肝癌的疗效进行评价：中医治疗组相对于西医对照组,瘤体有效率：相对危险度RR=1.54,95%可信区间(1.34-1.76)、瘤体稳定率：相对危险度RR为=1.58,95%可信区间(1.33-1.87)、生活质量(卡氏评分)稳定率：相对危险度RR为=1.49,95%可信区间(1.34-1.65)、半年生存率：相对危险度RR为=1.66,95%可信区间(1.32-2.09)；分别对四个指标进行总体效应假设检验,P<0.05,都具有统计学意义；
2、对浙江省中医院的原发性肝癌伴门脉癌栓进行回顾性分析,有162份病例入选,运用加权百分率法进行统计,涉及原发性肝癌伴门脉癌栓常见辩证分型依次是：脾虚证、肝郁证、肝郁脾虚证、脾虚湿困证(蕴／组)、气滞证、阴虚证、湿热证、血瘀证、气滞血瘀证等；常用的中药是：茯苓、白术、米仁、猪苓、鸡内金、山药、八月札、蛇舌草、太子参等；涉及的中药种类有：健脾益气、疏肝理气、清热解毒、化湿药、利水渗湿、理气药、活血化瘀等；按照浙江省中医院肝癌中医单病种标准进行分类,常见证型及其中药：脾虚证：(包括脾虚证、脾虚湿困／蕴／组、肝郁脾虚)茯苓、白术、米仁、猪苓、鸡内金、山药、八月札、蛇舌草、太子参等,气滞证：(包括气滞证、肝郁气滞)柴胡、郁金、八月札、白芍、陈皮、猫爪草、川楝子、枳壳、木香等,血瘀证：郁金、丹参、元胡、赤芍、枳壳、莪术、桃仁、红花、三菱、丹皮、川芎、延胡索等,湿热证：(肝胆湿热、湿热证)：柴胡、白芍、茵陈、垂盆草、金钱草、海金沙、黄芩、黄连、黄柏、川朴、苍术等,阴虚证：生地、熟地、红枣、白芍、北沙参、南沙参、枸杞子、麦冬、石斛、五味子、鳖甲、青蒿等。
结论：1、中医药治疗晚期原发性肝癌的疗效进行评价：得出：
1.1中医药治疗组在瘤体有效率方面优于西医对照组,即中医药或中西医结合治疗晚期肝癌在瘤体有效率方面优于西医治疗晚期肝癌；
1.2中医药治疗组在瘤体稳定率方面优于西医对照组,即中医药或中西医结合治疗晚期肝癌在瘤体稳定率方面优于西医治疗晚期肝癌；
1.3中医药治疗组在生活质量(卡氏评分稳定)稳定率方面优于西医对照组,即中医药或中西医结合治疗晚期肝癌在生活质量(卡氏评分稳定)稳定率方面优于西医治疗晚期肝癌。
1.4中医药治疗组在半年生存率方面优于西医对照组,即中医药或中西医结合治疗晚期肝癌在半年生存率方面优于西医治疗晚期肝癌。
2对原发性肝癌伴门静脉癌栓病例进行回顾性分析,得出
2.1常见辩证分型以：脾虚证、肝郁脾虚证、脾虚湿困证最多见,其次是肝郁气滞证、湿热证、阴虚证；
2.2常见中药种类：益气健脾、疏肝理气、化湿药、利水渗湿等；
2.3常见的中药有：茯苓、白术、米仁、猪苓、鸡内金、山药、八月札、蛇舌草、太子参、党参等；
Objective:
1. Using Meta analysis software of traditional Chinese medicine for treatment of advanced hepatocellular carcinoma systematic evaluation.
2. Retrospective analysis of patients with primary liver cancer with portal vein tumor thrombus of dialectical argumentation, its Chinese dialectical classification and summary of the common drug laws.
Methods:
1. Using Meta analysis software system for evaluation of Chinese medicine for treatment of advanced primary liver cancer, which traditional Chinese medicine treatment of hepatocellular carcinoma with portal vein tumor thrombus to evaluate the efficacy. Through the years 1999-2008 published in Chinese medicine for treatment of advanced primary liver cancer and the treatment of modern Western medicine as a control group, randomized controlled study of literature search, According to selected, excluding standard-setting selected papers, selected literature on the quality evaluation of literature, the outcome of the literature data taking, using RevMan4.2 (Review Manager) software for statistical analysis, obtained Meta analysis, and conduct bias and sensitivity to analysis.
2. Through the Chinese medicine hospital in Zhejiang province during the period 2003-2009, primary liver cancer with portal vein tumor thrombus cases of the collection, According to selected, excluding the standard for ascertaining the successful cases, a retrospective of selected cases of dialectical sub-types of TCM, Chinese medicine treatment (hospitalization for the first time a prescription medicine), and liver function in Child classification was extracted, using the weighted percentage method statistics, obtained primary liver cancer with portal vein tumor thrombus in the dialectic of traditional Chinese medicine Chinese medicine sub-type and common use of the law.
Results:
l.This study included a total of 28 about the Chinese medicine for treatment of advanced primary liver cancer randomized controlled trials, the use of Meta analysis of traditional Chinese medicine for treatment of advanced hepatocellular carcinoma evaluated:Chinese medicine treatment group compared to Western medicine control group, Efficient tumor:RR (relative risk)=1.54,95% confidence interval (1.34-1.76), stable tumor rate:RR (relative risk)=1.58,95% confidence interval (1.33-1.87), Quality of life (Karnofsky score) stable rate:RR(relative risk)=1.49,95% confidence interval (1.34-1.65),Half a year survival rate:RR(relative risk)=1.66,95% confidence interval (1.32-2.09); Distribution of the four indicators, the overall effect of hypothesis testing, P<0.05, both statistically significant.
2.Chinese medicine hospital in Zhejiang Province of primary liver cancer with portal vein tumor thrombus were analyzed retrospectively,162 cases were selected, using the weighted percentage method statistics, Primary liver cancer with portal vein tumor thrombus involving the dialectical classification common are:spleen, liver depression, liver depression Spleen, Spleen wet storm (Yun/group), qi stagnation, yin deficiency, damp heat, blood stasis, qi stagnation of blood stasis, etc. Commonly used in traditional Chinese medicine are:Fuling、Baizhu、Miren、Zhuling、Jineijin、Shanyao、Bayuezha、Sheshecao、Taizishe、etc. There are several varieties of Chinese medicine involving:spleen Qi, Shugan Qi, heat detoxification, Huashi drugs, diuresis Shenshi, Qi drugs, blood circulation, etc. Common Syndromes and Chinese Medicine:Spleen Deficiency Syndrome:(including the spleen deficiency syndrome, spleen deficiency wet storm/Yun/group, Liver depression and spleen) Fuling、Baizhu、Miren、Zhuling、Jineijin、Shanyao、Bayuezha、Sheshecao、Taizishen, etc. Qi stagnation: (including air stagnation, qi stagnation) Chaihu、Yujin、Bayuezha、Baoshao、Chenpi、Maozhuacao、Chuanlianzi、Zhike、Muxiang、etc. Blood stasis:Yujin、Danshen、Yuanhu、Chishao、Zhiqiao、Ezhu、Taoren、Honghua、Shanling、Danpi、Chuanxiong、Yanhusuo etc. Damp-heat:(liver and gallbladder damp-heat, damp-heat syndrome): Chaihu、Baishao、Yinchen、Chuipencao、Jinqiancao、Haijinsha、Huangjin、Huanglian、Huangbo、Chuanpu、Cangzhu、etc. Yin deficiency:Shengdi、Shudi、Hongzao、Baishao、Beishashen、Nanshashen、Gouqizi、Maidong、Shihu、Wuweizi、Biejia、Qinghao, and so on.
Conclusion:
1. Chinese medicine treatment of advanced hepatocellular carcinoma evaluated: drawn:
1.1 Chinese medicine treatment group was superior to Western medicine effective tumor control group, that is, combination of Chinese medicine or TCM treatment of advanced liver cancer tumors and efficient in the treatment of advanced liver cancer was superior to Western medicine;
1.2 Chinese medicine treatment group stability and the rate of tumor control group was superior to Western medicine, namely, Chinese medicine or TCM treatment of advanced hepatocellular carcinoma with a stable rate in the tumor is superior to Western medicine for treatment of advanced liver cancer;
1.3 Chinese medicine treatment group quality of life (Karnofsky score stability) and stability rates of the control group was superior to Western medicine, namely, Chinese medicine or combination of Chinese and Western medicine for treatment of advanced liver cancer in the quality of life (Karnofsky score stability) is superior to Western medical treatment of stable rates advanced liver cancer.
1.4Chinese medicine treatment group survival rate was superior to Western medicine in six months the control group, that is, combination of Chinese medicine or TCM treatment of advanced liver cancer survival rate in six months is superior to Western medicine for treatment of advanced liver cancer.
2 Pairs of primary hepatocellular carcinoma with portal vein tumor thrombus retrospectively analyzed with
2.1 Common Syndromes to:Spleen Deficiency Syndrome, Liver depression and spleen deficiency, spleen deficiency wet storm most common, followed by the liver Qi stagnation, Damp-heat, yin deficiency syndrome;
2.2 Common types of traditional Chinese medicine:Qi and spleen, Shugan qi, dampness drugs, diuresis. Shenshi and so on;
2.3 Common traditional Chinese medicine are:Fuling、Baizhu、Miren、Zhuling、Jineijin、Shanyao、Bayuezha、Sheshecao、Taizishen、Dangshen etc.
引文
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