Wang Qing, Ye Hui, Wang Qiu-Qin, Li Wei-Tong, Yu Bei-Bei, Bai Ya-Mei, Xu Gui-Hua
School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China.
Public Teaching Department for Foreign Languages, Nanjing University of Chinese Medicine, Nanjing, China.
Front Pharmacol. 2021 May 4;12:573500. doi: 10.3389/fphar.2021.573500. eCollection 2021.
We conducted a systematic review of high-quality randomized controlled trials (RCTs) to assess the efficacy and safety of Chinese herbal medicine (CHM) for the treatment of chemotherapy-induced leukopenia (CIL). Eight electronic databases were searched from the date of inception to November 4, 2020 for high-quality RCTs that met the requirements of at least four key domains of the Cochrane risk of bias (RoB) tool. RevMan 5.3 was applied for the meta-analysis. Fourteen RCTs involving 1,053 patients were included. The pooled results showed that CHM + chemotherapy exerted greater beneficial effects on white blood cell (WBC), neutrophil (NEU), hemoglobin (Hb), and platelet (PLT) counts in addition to the Karnofsky performance scale (KPS) score, but showed no significant difference on granulocyte colony-stimulating factor (G-CSF) dosage compared with chemotherapy alone. Placebo (PBO) + chemotherapy and CHM + chemotherapy groups showed no significant differences in terms of reduction of the incidence of neutropenia. CHM + chemotherapy was superior to Western medicine (WM) + chemotherapy in improving the WBC count, KPS, infection amount, G-CSF use rate, and incidence of leukopenia. In addition, no severe adverse events were observed in the 14 RCTs. CHM in combination with chemotherapy could effectively improve the clinical symptoms of CIL when compared with chemotherapy alone or Western medicine + chemotherapy, except when comparing with PBO + chemotherapy. While CHMs were generally safe for clinical use and exerted no severe side effects in the 14 RCTs, high-quality RCTs with larger sample sizes are essential to reduce study heterogeneity.
我们对高质量随机对照试验（RCT）进行了系统评价，以评估中药治疗化疗引起的白细胞减少症（CIL）的疗效和安全性。从各数据库建库至2020年11月4日，检索了8个电子数据库，查找符合Cochrane偏倚风险（RoB）工具至少四个关键领域要求的高质量RCT。应用RevMan 5.3进行荟萃分析。纳入了14项涉及1053例患者的RCT。汇总结果显示，与单纯化疗相比，中药联合化疗除了对卡氏功能状态量表（KPS）评分有更大益处外，对白细胞（WBC）、中性粒细胞（NEU）、血红蛋白（Hb）和血小板（PLT）计数也有更大益处，但在粒细胞集落刺激因子（G-CSF）剂量方面无显著差异。安慰剂（PBO）联合化疗组和中药联合化疗组在中性粒细胞减少症发生率降低方面无显著差异。中药联合化疗在改善白细胞计数、KPS、感染量、G-CSF使用率和白细胞减少症发生率方面优于西药联合化疗。此外，在这14项RCT中未观察到严重不良事件。与单纯化疗或西药联合化疗相比，中药联合化疗在与PBO联合化疗比较除外的情况下，可有效改善CIL的临床症状。虽然中药在临床使用中总体安全，且在这14项RCT中未产生严重副作用，但仍需要大样本量的高质量RCT来减少研究异质性。
