中医药防治乳腺癌蒽环类化疗药物致心脏毒性疗效的Meta分析

发布时间：2018-07-21 15:29

【摘要】：目的:通过Meta分析的方法,对所收集的原始研究数据进行分析,综合评价中医药防治乳腺癌蒽环药物化疗导致的心脏毒性的疗效。材料与方法:以“中医药”“乳腺癌”“蒽环类药物”“心脏毒性”“Traditional Chinese Medision”“breast cancer”“Anthracycline drugs”“cardiac toxicity”为关键词检索万方、维普、CNKI、Pubmed数据库。按纳入标准筛选文献,采用Review Manager 5.3软件对文献进行Meta分析,文中所涉及的二分类变量采用相对危险度(risk ratio)以及95%置信区间(CI)进行表示,连续性变量采用标准均数差(SMD)表示,各效应量采用95%CI表示,分析P值及I2,如P0.1、I2≥50%,则提示各研究间存在异质性,采用随机效应模型进行分析,反之不存在异质性,采用固定效应模型分析。观察漏斗图对否对称,从而判断文章是否存在发表偏倚。结果:1.检索文献结果筛选纳入18篇关于中医药防治乳腺癌蒽环类化疗心脏毒性的随机对照试验(randomized controlled trials,RCTs),共1998例患者。2.Meta分析结果Meta分析结果提示,与对照组相比,试验组能够降低心脏损伤的各项指标,减少LVEF的降低幅度[SMD=1.02,95%CI(0.56,1.48),P0.0001],降低c Tn I、c Tn T的升高幅度[SMD=-3.05,95%CI(-5.63,-0.47),P=0.02],[SMD=-1.36,95%CI(-2.13,-0.58),P=0.0006],降低CK-MB的升高幅度[SMD=-3.90,95%CI(-6.68,-1.11),P=0.006],减少心电图期前收缩的发生率[RR=0.46,95%CI(0.31,0.67),P0.0001],降低ST-T段异常的发生率[RR=0.55,95%CI(0.41,0.73),P0.0001]。结论:Meta分析结果显示,与对照组相比,中药联合蒽环类化疗能够降低乳腺癌蒽环类化疗药物产生的心脏毒性,且在左室射血分数、肌钙蛋白、CK-MB及心电图等指标上均表现出显著疗效,故推荐临床应用。
[Abstract]:Objective: to analyze the original data collected by Meta analysis, and to evaluate the efficacy of traditional Chinese medicine on the prevention and treatment of cardiac toxicity caused by anthracycline chemotherapy in breast cancer. Materials and methods: "Chinese medicine" "breast cancer" "anthracycline" "heart toxicity" "Traditional Chinese Medision" "breast can "Cer" "Anthracycline drugs" "cardiac toxicity" for keyword retrieval of Wanfang, VP, CNKI, Pubmed database. According to the inclusion criteria, the literature is selected by Review Manager 5.3 software for Meta analysis. The two classified variables involved in this article are represented by relative risk degree (risk ratio) and 95% confidence interval. The continuity variable is expressed by standard mean difference (SMD), and the effect quantity is expressed by 95%CI. The analysis of P and I2, such as P0.1, I2 > 50%, indicates the existence of heterogeneity in each study, and the random effect model is used to analyze it, and on the contrary, there is no heterogeneity, and a fixed effect model is used to analyze whether the funnel map is symmetrical or not, so as to judge whether the article exists or not. Results: 1. retrieval literature results were selected to include 18 randomized controlled trials (randomized controlled trials, RCTs) for the prevention and control of the heart toxicity of anthracycline chemotherapy in breast cancer. A total of 1998 patients with.2.Meta analysis showed that the results of Meta analysis were compared with the control group, and the experimental group could reduce the indexes of heart damage. Reduce the amplitude of [SMD=1.02,95%CI (0.56,1.48), P0.0001], reduce C Tn I, C Tn T increase amplitude [SMD=-3.05,95%CI. P0.0001], reducing the incidence of ST-T segment abnormalities [RR=0.55,95%CI (0.41,0.73), P0.0001]. conclusion: Meta analysis showed that the combination of Chinese medicine and anthracycline chemotherapy, compared with the control group, could reduce the cardiac toxicity of anthracycline chemotherapy drugs in breast cancer, and showed significant differences in left ventricular ejection fraction, troponin, CK-MB, and electrocardiogram. As a result, clinical application is recommended.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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