中药注射剂联合化疗治疗胰腺癌的网络荟萃分析

Network meta-analysis of Chinese herbal injections combined with the chemotherapy for the treatment of pancreatic cancer.

作者信息

Zhang Dan, Wu Jiarui, Liu Shi, Zhang Xiaomeng, Zhang Bing

机构信息

Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China.

出版信息

Medicine (Baltimore). 2017 May;96(21):e7005. doi: 10.1097/MD.0000000000007005.

BACKGROUND

This study sought to use a network meta-analysis to assess the effectiveness and safety of Chinese herbal injections (CHIs) combined with the chemotherapy for the treatment of pancreatic cancer.

METHODS

Randomized controlled trials (RCTs) regarding CHIs to treat pancreatic cancer were searched in PubMed, the Cochrane library, Embase, the China National Knowledge Infrastructure Database (CNKI), the Wan-Fang Database, the Chinese Scientific Journals Full-text Database (VIP), and the Chinese Biomedical Literature Database (SinoMed) up to November 2016. The quality assessment was conducted by the Cochrane risk of bias tool and network meta-analysis was performed to compare the effectiveness and safety of different CHIs combined with the chemotherapy. Data were analyzed using STATA 12.0 and Win-BUGS 1.4 software.

RESULTS

A total of 278 records were searched, and 22 eligible RCTs involving 1329 patients and 9 CHIs were included. The results of the network meta-analysis demonstrated that compared with the chemotherapy alone, Compound Kushen, Kangai or Kanglaite injection combined with chemotherapy yielded significantly higher probability of improving performance status. Aidi injection combined with chemotherapy was more effective in relieving leucopenia than using chemotherapy single. And these between-group differences were statistically significant. However, CHIs combined with chemotherapy could not achieve a better effect in the total clinical effect, nausea and vomiting. As for the cluster analysis for the adverse reactions (ADRs), the chemotherapy alone and Huachansu injection combined with the chemotherapy were inferior to relieve ADRs than the other CHIs plus chemotherapy for patients with pancreatic cancer.

CONCLUSIONS

The current evidence showed that using CHIs on the basis of the chemotherapy could be beneficial for patients with pancreatic cancer in improving performance status and reducing the ADRs.

背景

本研究旨在运用网络荟萃分析评估中药注射剂（CHIs）联合化疗治疗胰腺癌的有效性和安全性。

方法

截至2016年11月，在PubMed、Cochrane图书馆、Embase、中国知网数据库（CNKI）、万方数据库、维普中文科技期刊全文数据库（VIP）和中国生物医学文献数据库（SinoMed）中检索关于CHIs治疗胰腺癌的随机对照试验（RCTs）。采用Cochrane偏倚风险工具进行质量评估，并进行网络荟萃分析以比较不同CHIs联合化疗的有效性和安全性。使用STATA 12.0和Win-BUGS 软件进行数据分析。

结果

共检索到278条记录，纳入22项符合条件的RCTs，涉及1329例患者和9种CHIs。网络荟萃分析结果表明，与单纯化疗相比，复方苦参、康艾或康莱特注射液联合化疗使患者体能状态改善的概率显著更高。艾迪注射液联合化疗在缓解白细胞减少方面比单纯化疗更有效。这些组间差异具有统计学意义。然而，CHIs联合化疗在总临床疗效、恶心和呕吐方面未能取得更好效果。至于不良反应（ADRs）的聚类分析，对于胰腺癌患者，单纯化疗以及华蟾素注射液联合化疗在缓解ADRs方面不如其他CHIs联合化疗。