中药治疗中晚期非小细胞肺癌的Meta分析
发布时间：2018-07-22 17:27
【摘要】：【目的】通过Meta分析方法,对既往相关文献进行归纳整理,评价中药与一线化疗方案对比治疗中晚期非小细胞肺癌的临床疗效。【方法】采用电子网络及手工检索相互交叉的检索方式,国内文库选用:相关期刊论文(CNKI,1984-2016.12)、重庆维普数据库(VIP,1989-2016.12)、万方数据库(Wanfang,1980-2016.12)、中国生物医学文献数据库(CBM,1978-2016.12);外文文库选用:PubMed(1966-2016.12)、Cochrane Library(1988-2016.12)数据库随机对照试验的文献。语言限定为中文、英文。严格按照纳入标准与排除标准对检索出的文献进行筛选,其结果运用Meta分析常用软件Review manager5.3进行Meta分析,对纳入文献进行Meta分析时,二分类变量使用相对危险度RR,时间-事件变量使用风险比HR,异质性检验采用卡方检验,采用固定或随机效应模型对纳入研究文献的结果进行Meta分析。结局指标包括:瘤体总有效率;瘤体稳定率;生活质量KPS评分改善率。【搜索结果】共纳入14篇符合纳入标准的文献,涉及病例数总共798例。其中有关单纯中药对照一线化疗方案治疗中晚期非小细胞肺癌的瘤体总有效率及瘤体稳定率的所纳入的文献相同,共13篇文献,涉及病例数共758例;单纯中药对照一线化疗方案治疗中晚期非小细胞肺癌的生活质量KPS评分改善率的研究共纳入7个篇文献,涉及病例数共351例。【Meta分析结果显示】1.单纯使用中药较单纯使用一线化疗方案在治疗中晚期非小细胞肺癌临床瘤体总有效率方面无优势。X2=16.55,df=12,p=0.170.05,I2=28%50%,各个研究间异质性较低,采用固定效应模型,结果显示:RR=0.50,[95%CI(0.36,0.68)],效应量检验Z=4.36(P0.0001),具有统计学意义。2.单纯使用中药较单纯使用一线化疗方案在治疗中晚期非小细胞肺癌临床瘤体稳定率方面治疗效果相近。X2=10.46,df=12,p=0.580.05,I2=050%,各个研究间异质性较低,同质性较好,采用固定效应模型,结果显示:RR=0.99,[95%CI(0.90,1.09)],效应量检验Z=0.15(P=0.880.05),不具有统计学意义。3.单纯使用中药较单纯使用一线化疗方案在生活质量KPS评分改善率方面有较大优势。X2=3.49,df=6,p=0.740.05,I2=0%50%,各个研究间异质性较低,具有良好的同质性,采用固定效应模型,结果显示:RR=2.53,[95%CI(1.94,3.30)],效应量检验Z=6.38(P0.00001),具有统计学意义。纳入的14篇文献均为RCT,其中有6篇文献提及具体随机方式,其余8篇分组方法中仅提及"随机"二字,并未对随机方法进行具体说明,所有研究仅有1篇文献提及分配隐藏,因此存在一定的选择性偏倚。所有纳入文献中仅1篇文章提及双盲法,3篇文献提及使用单盲法,其余文献均未提及是否使用盲法,故存在测量性偏倚和实施性偏倚等偏倚风险。[结论]单纯中药相较于单纯一线化疗方案在治疗中晚期非小细胞肺癌生活质量KPS评分改善率方面有一定的优势,在临床瘤体稳定率方面疗效相近,在临床瘤体总有效率方面无优势。
[Abstract]:[objective] to summarize and sort out the related literatures by meta-analysis. To evaluate the clinical efficacy of traditional Chinese medicine and first-line chemotherapy in the treatment of advanced non-small cell lung cancer. The selection of domestic databases: CNKI full text Database (CNKI) 1984-2016.12, Chongqing Weipu Database (VIPB) 1989-2016.12, Wanfang Database 1980-2016.12, Chinese Biomedical Literature Database (CBM1978-2016.12), and Foreign language Database selected the literature of the randomized controlled trial of the Chinese Library Cochrane (1988-2016.12). The language is limited to Chinese and English. According to the inclusion criteria and exclusion criteria, the retrieved documents were screened. The results were analyzed by Meta-analysis software manager5.3. Two classification variables use relative risk RR, time-event variable use risk ratio HR. heterogeneity test is chi-square test, fixed or random effect model is used to conduct Meta-analysis of the results included in the research literature. The outcome indicators included: total effective rate, tumor stability rate, KPS score improvement rate of quality of life. [search results] included 14 articles that met the inclusion criteria, involving a total of 798 cases. Among them, the total effective rate and tumor stability rate of patients with advanced non-small cell lung cancer treated with traditional Chinese medicine alone were the same, 13 articles were involved, and 758 cases were involved. The study on the improvement rate of quality of life (QOL) score in non-small cell lung cancer (NSCLC) treated by traditional Chinese medicine (TCM) with first-line chemotherapy was included in 7 articles, involving 351 cases. [Meta-analysis results] 1. There was no advantage in the total effective rate of treating middle and advanced non-small cell lung cancer with traditional Chinese medicine alone as compared with first-line chemotherapy regimen. The total effective rate of the treatment was 0.170.05 I2T28P.There was no advantage in the total effective rate of treatment of middle and advanced non-small cell lung cancer. The heterogeneity of each study was lower, and the fixed effect model was adopted. The results showed that: RRN 0.50, [95% CI (0.36% 0.68)], the effect quantity test was 4.36 (P 0.0001), which was statistically significant. The clinical stability rate of NSCLC treated by traditional Chinese medicine alone was similar to that of first-line chemotherapy regimen alone. X2O10. 46dfU 12p 0.580.05 I2C0500.The heterogeneity and homogeneity of each study were lower and better. The fixed effect model was used for the treatment of non-small cell lung cancer (NSCLC) in the middle and advanced stage, and the stability of the tumor was similar to that of the first-line chemotherapy regimen in the treatment of advanced non-small cell lung cancer (NSCLC). The results showed that: RRN was 0.99, [95% CI (0.90 卤1.09)], and the effect quantity test was 0.15 (P0. 880.05), which had no statistical significance. Compared with first-line chemotherapy alone, the improvement rate of KPS score in quality of life (KPS) was better than that of traditional Chinese medicine alone. The improvement rate of KPS score of QOL was better than that of traditional Chinese medicine alone. The improvement rate of KPS score of QOL was better than that of first-line chemotherapy alone. The improvement rate of KPS score was higher than that of first-line chemotherapeutic regimen. The heterogeneity of each study was lower and had good homogeneity. The results showed that: RRN 2.53, [95% CI (1.94 卤3.30)], the effect quantity test was 6.38 (P0.00001), which had statistical significance. The 14 articles included were all RCTs, of which 6 mentioned specific random methods, the remaining 8 mentioned only the word "random" without specifying the random methods, and only one of the studies mentioned assignment and concealment. Therefore, there is a certain selective bias. Only one article mentioned the double blind method and three mentioned the use of the single blind method in all the literatures, and the others did not mention whether or not to use the blind method. Therefore, there was a risk of bias, such as measurement bias and operational bias. [conclusion] compared with first-line chemotherapy alone, traditional Chinese medicine has some advantages in the improvement rate of KPS score in the treatment of intermediate and advanced non-small cell lung cancer, and the curative effect is similar in the clinical stability rate of non-small cell lung cancer. There is no advantage in the total effective rate of clinical tumor.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2
本文编号：2138213
[Abstract]:[objective] to summarize and sort out the related literatures by meta-analysis. To evaluate the clinical efficacy of traditional Chinese medicine and first-line chemotherapy in the treatment of advanced non-small cell lung cancer. The selection of domestic databases: CNKI full text Database (CNKI) 1984-2016.12, Chongqing Weipu Database (VIPB) 1989-2016.12, Wanfang Database 1980-2016.12, Chinese Biomedical Literature Database (CBM1978-2016.12), and Foreign language Database selected the literature of the randomized controlled trial of the Chinese Library Cochrane (1988-2016.12). The language is limited to Chinese and English. According to the inclusion criteria and exclusion criteria, the retrieved documents were screened. The results were analyzed by Meta-analysis software manager5.3. Two classification variables use relative risk RR, time-event variable use risk ratio HR. heterogeneity test is chi-square test, fixed or random effect model is used to conduct Meta-analysis of the results included in the research literature. The outcome indicators included: total effective rate, tumor stability rate, KPS score improvement rate of quality of life. [search results] included 14 articles that met the inclusion criteria, involving a total of 798 cases. Among them, the total effective rate and tumor stability rate of patients with advanced non-small cell lung cancer treated with traditional Chinese medicine alone were the same, 13 articles were involved, and 758 cases were involved. The study on the improvement rate of quality of life (QOL) score in non-small cell lung cancer (NSCLC) treated by traditional Chinese medicine (TCM) with first-line chemotherapy was included in 7 articles, involving 351 cases. [Meta-analysis results] 1. There was no advantage in the total effective rate of treating middle and advanced non-small cell lung cancer with traditional Chinese medicine alone as compared with first-line chemotherapy regimen. The total effective rate of the treatment was 0.170.05 I2T28P.There was no advantage in the total effective rate of treatment of middle and advanced non-small cell lung cancer. The heterogeneity of each study was lower, and the fixed effect model was adopted. The results showed that: RRN 0.50, [95% CI (0.36% 0.68)], the effect quantity test was 4.36 (P 0.0001), which was statistically significant. The clinical stability rate of NSCLC treated by traditional Chinese medicine alone was similar to that of first-line chemotherapy regimen alone. X2O10. 46dfU 12p 0.580.05 I2C0500.The heterogeneity and homogeneity of each study were lower and better. The fixed effect model was used for the treatment of non-small cell lung cancer (NSCLC) in the middle and advanced stage, and the stability of the tumor was similar to that of the first-line chemotherapy regimen in the treatment of advanced non-small cell lung cancer (NSCLC). The results showed that: RRN was 0.99, [95% CI (0.90 卤1.09)], and the effect quantity test was 0.15 (P0. 880.05), which had no statistical significance. Compared with first-line chemotherapy alone, the improvement rate of KPS score in quality of life (KPS) was better than that of traditional Chinese medicine alone. The improvement rate of KPS score of QOL was better than that of traditional Chinese medicine alone. The improvement rate of KPS score of QOL was better than that of first-line chemotherapy alone. The improvement rate of KPS score was higher than that of first-line chemotherapeutic regimen. The heterogeneity of each study was lower and had good homogeneity. The results showed that: RRN 2.53, [95% CI (1.94 卤3.30)], the effect quantity test was 6.38 (P0.00001), which had statistical significance. The 14 articles included were all RCTs, of which 6 mentioned specific random methods, the remaining 8 mentioned only the word "random" without specifying the random methods, and only one of the studies mentioned assignment and concealment. Therefore, there is a certain selective bias. Only one article mentioned the double blind method and three mentioned the use of the single blind method in all the literatures, and the others did not mention whether or not to use the blind method. Therefore, there was a risk of bias, such as measurement bias and operational bias. [conclusion] compared with first-line chemotherapy alone, traditional Chinese medicine has some advantages in the improvement rate of KPS score in the treatment of intermediate and advanced non-small cell lung cancer, and the curative effect is similar in the clinical stability rate of non-small cell lung cancer. There is no advantage in the total effective rate of clinical tumor.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2
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