中药对AIs、TAM治疗乳腺癌的不良反应的干预效果系统评价

发布时间：2018-07-18 14:58

【摘要】：目的立足于循证医学,根据Cochrane协作网的方法,评价中药对AIs及TAM治疗乳腺癌所致不良反应的干预作用,为使用中药干预AIs、TAM治疗乳腺癌的不良反应提供参考依据。方法根据Cochrane协作网的方法,以及各数据库的特点,和文献的纳入排除标准,设计出合理有效的文献检索策略。应用计算机检索Cochrane图书馆、PubMed,EM Base、中国知识资源总库(CNKI)、万方数据库、维普数据库,收集中医药联合AIs及TAM药物治疗乳腺癌的随机对照试验,检索时限为从建库至2017年2月,检索截止日期为2017年2月1日,提取相关资料,应用RevMan5.3软件进行Met a分析及定性的系统评价。结果共检索到1498篇文献,最终纳入全文文献24篇,全部为中文文献。对腰椎骨密度BMD的影响Meta分析:合并MD值为0.09,95%可信区间CI为[0.05,0.13],整体效果检验Z=4.15,P0.0001,差异显著,有统计学性意义;对子宫内膜厚度的Meta分析:合并MD值为-0.94,95%可信区间CI为[-1.63,-0.25],整体效果检验Z=2.68,P=0.0070.01,差异显著,有统计学性意义;对改良kupperman评分的Meta分析:合并MD值为-16.13,95%可信区间CI为[-18.89,-13.36],整体效果检验Z=11.44,P0.00001,差异有显著意义;对血清E2的Meta分析:合并SMD值为0.00,95%可信区间CI为[-0.25,0.26],整体效果检验Z=0.02,P=0.990.05,表明用药前后无差异,漏斗图不对称,存在发表偏倚的可能;对卡氏评分的Meta分析:合并SMD值为5.00,95%可信区间CI为[2.89,7.11],整体效果检验Z=4.65,P=0.00001,差异显著,有统计学意义;对外周血CD4~+计数的Meta分析:合并MD值为3.18,95%可信区间CI为[0.77,5.60],整体效果检验Z=2.58,P=0.010.05,差异有统计学意义;对外周血CD8~+计数的Meta分析:合并MD值为-2.73,95%可信区间CI为[-3.42,-2.04],整体效果检验Z=7.75,P0.00001,差异显著,有统计学意义;对外周血CD4~+/CD8~+的Meta分析:合并MD值为0.27,95%可信区间CI为[0.20,0.33],整体效果检验Z=7.88,P0.00001,差异显著,有统计学意义;对CA125的Meta分析:合并MD值为-1.56,95%可信区间CI为[-3.78,0.66],整体效果检验Z=1.38,P=0.170.05,表明用药前后无差异;对血清总胆固醇的系统评价:仍需纳入更多文献;对CA153的影响系统评价:指向指向中药干预下CA153有所降低,仍需更多大样本、高质量研究支持;未证明中药配合AI、TAM产生不良反应,仍需纳入更多文献。结论中药配合TAM治疗乳腺癌较单纯使用TAM相比,患者kupperman评分更低;配合AIs药物治疗乳腺癌较不使用中药相比,患者的BMD更高;配合TAM治疗乳腺癌较单纯使用TAM相比,子宫内膜厚度更薄;配合TAM治疗乳腺癌,未证明中药对FSH有影响;配合AIs、TAM内分泌药治疗乳腺癌,未证明对E2有影响;配合TAM治疗乳腺癌较单纯使用TAM,患者KPS评分更高;配合AIs、TAM内分泌药治疗乳腺癌,CD4~+计数更高;辅助AIs、TAM治疗乳腺癌,CD8~+计数更低;配合AIs、TAM内分泌药治疗乳腺癌,CD4~+/CD8~+比值更低;辅助AIs、TAM治疗乳腺癌,未证明对CA125产生影响。对血清胆固醇、CA153、中药不良反应的评价,尚需要纳入基线一致、质量更高的文献进行评价。使用中药配合AIs、TAM治疗乳腺癌,较不使用中药相比,部分不良反应的症状及实验室指标更轻,免疫细胞计数更优,未证明对E2、FSH有影响。但有待纳入大样本、高质量的随机对照试验进行更严谨的系统评价,下一步应对个体患者的临床重要改变进行评估,对中医证型进行分组分析。
[Abstract]:Objective based on evidence-based medicine and based on the method of Cochrane cooperation network, the intervention effect of traditional Chinese medicine on the adverse reactions caused by AIs and TAM in the treatment of breast cancer was evaluated, and the reference basis was provided for the use of traditional Chinese medicine to interfere with AIs and TAM in the treatment of breast cancer, according to the formula of the Cochrane cooperation network, the characteristics of each database, and the inclusion of the literature. In addition to the standard, a reasonable and effective literature retrieval strategy is designed. Using computer to retrieve Cochrane library, PubMed, EM Base, Chinese general library of knowledge resources (CNKI), Wanfang database, VP database, a randomized controlled trial of combining traditional Chinese medicine with AIs and TAM drugs in the treatment of breast cancer, the retrieval time limit is from the construction to the February 2017, the search cut-off day In February 1, 2017, the relevant data were extracted and RevMan5.3 software was used to perform Met a analysis and qualitative systematic evaluation. Results a total of 1498 articles were retrieved and 24 articles were included in the full text literature. All of them were Chinese literature. The effect of Meta analysis on the BMD of lumbar bone mineral density: the combined MD value of 0.09,95% confidence interval CI was [0.05,0.13], and the overall effect was tested Z. =4.15, P0.0001, significant difference, statistically significant; Meta analysis of endometrial thickness: MD value is -0.94,95% confidence interval CI [-1.63, -0.25], the overall effect of Z=2.68, P=0.0070.01, significant difference, and statistically significant; 3.36], the overall effect test Z=11.44, P0.00001, the difference is significant; the Meta analysis of serum E2: the combined SMD value of 0.00,95% confidence interval CI is [-0.25,0.26], the overall effect test Z=0.02, P=0.990.05, indicates that there is no difference between the drugs before and after the drug use, the funnel plot asymmetry, the possibility of the bias of the hair table; the Meta analysis of the card score: the combined value of 5 0,95% confidence interval CI is [2.89,7.11], the overall effect test Z=4.65, P=0.00001, significant difference, statistically significant; Meta analysis of CD4~+ count in peripheral blood: MD value is 3.18,95% confidence interval CI [0.77,5.60], the whole effect test Z=2.58, the difference has the significance of unified planning; The -2.73,95% confidence interval CI is [-3.42, -2.04], the overall effect test Z=7.75, P0.00001, significant difference, statistically significant; the Meta analysis of the peripheral blood CD4~+/CD8~+: the MD value is 0.27,95% confidence interval CI [0.20,0.33]. -1.56,95% confidence interval CI is [-3.78,0.66], the overall effect test Z=1.38, P=0.170.05, show no difference before and after drug use; the systematic evaluation of serum total cholesterol: still need to include more literature; evaluation of the influence of CA153: pointing to the intervention of Chinese medicine intervention CA153 has decreased, still need more large samples, high quality research support; Chinese traditional medicine is not proved. It is still necessary to incorporate more literature with AI and TAM. Conclusion the Kupperman score of the patients with breast cancer with TAM is lower than that of TAM alone, and the BMD is higher in the patients with breast cancer than that of the traditional Chinese medicine. The endometrial thickness is thinner compared with the simple use of TAM in the treatment of breast cancer with TAM. TAM treatment of breast cancer has not proved that traditional Chinese medicine has an impact on FSH, and with AIs, TAM endocrine drugs are not proved to have an impact on E2, and that with TAM for breast cancer more than pure TAM and higher KPS score; with AIs, TAM endocrinology for breast cancer, CD4~+ count; adjuvant AIs, breast cancer, lower count Endocrine drugs in the treatment of breast cancer, CD4~+/CD8~+ ratio is lower; adjuvant AIs, TAM treatment of breast cancer, not proved to have an impact on CA125. Serum cholesterol, CA153, the evaluation of adverse effects of traditional Chinese medicine, still need to be included in the baseline, higher quality of the literature to evaluate. The use of traditional Chinese medicine with AIs, TAM for breast cancer, compared with the use of traditional Chinese medicine, compared with the use of traditional Chinese medicine, part of comparison, comparison of traditional Chinese medicine, part of the use of traditional Chinese medicine, comparison, comparison, comparison, comparison of traditional Chinese medicine, comparison, comparison, comparison of traditional Chinese medicine, comparison of some compared with traditional Chinese medicine, comparison of the use of traditional Chinese medicine, comparison, comparison, comparison of the use of traditional Chinese medicine, comparison, comparison, comparison of the use of traditional Chinese medicine, comparison, comparison, comparison of the use of traditional Chinese medicine, comparison, comparison, comparison of the use of traditional Chinese medicine, The symptoms and laboratory indicators of adverse reactions were lighter, the immune cell count was better, and the E2 and FSH had not been proved to be affected. However, the large sample was included, the high quality randomized controlled trial carried out a more rigorous systematic evaluation, the next step should be to evaluate the important clinical changes of the individual patients and analyze the TCM Syndrome Types in groups.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R273

【参考文献】