含半夏的中药联合 5-HT3RA 治疗化疗所致恶心呕吐的系统评价和 Meta 分析：22 项 RCT 的 PRISMA 一致性评价
Pinellia ternata-containing traditional Chinese medicine combined with 5-HT3RAs for chemotherapy-induced nausea and vomiting: A PRISMA-compliant systematic review and meta-analysis of 22 RCTs.
机构信息
Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau, China; College of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang, China; Department of Medical Oncology, the Affiliated Hospital of Hangzhou Normal University, College of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China.
Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau, China.
出版信息
Phytomedicine. 2023 Jul;115:154823. doi: 10.1016/j.phymed.2023.154823. Epub 2023 Apr 14.
BACKGROUND
Pinellia ternata (P. ternata, Banxia)-containing traditional Chinese medicine (TCM) is widely used in China as an adjuvant treatment for chemotherapy-induced nausea and vomiting (CINV). However, evidence of its efficacy and safety remains limited.
PURPOSE
To investigate the efficacy and safety of P. ternata-containing TCM combined with 5-hydroxytryptamine-3 receptor antagonists (5-HT3RAs) in the treatment of CINV.
STUDY DESIGN
Systematic review and meta-analysis of randomized controlled trials (RCTs).
METHODS
All relevant RCTs were systematically retrieved from seven internet databases (up to February 10, 2023). P. ternata-containing TCM combined with 5-HT3RAs to treat CINV was included in all RCTs. The clinical effective rate (CER) was defined as the primary outcome, while appetite, quality of life (QOL), and side effects were secondary outcomes.
RESULTS
The meta-analysis included 22 RCTs with 1,787 patients. Our results indicated that P. ternata-containing TCM combined with 5-HT3RAs significantly improved the CER of CINV (RR = 1.46, 95% CI = 1.37-1.57, p < 0.00001), appetite (RR = 1.77, 95% CI = 1.42-2.20, p < 0.00001), QOL (RR = 7.67, 95% CI = 1.56-13.78, p = 0.01), the CER of several 5-HT3RA medications (RR = 1.47, 95% CI = 1.37-1.57, p < 0.00001), and acute and delayed vomiting (RR = 1.23, 95% CI = 1.12-1.36, p < 0.0001) compared with the 5-HT3RAs alone, while the combination therapy decreased the incidence of side effects induced by 5-HT3RAs for CINV (RR = 0.50, 95% CI = 0.42-0.59, p < 0.00001).
CONCLUSION
According to the findings of this systematic review and meta-analysis, P. ternata-containing TCM combined with 5-HT3RAs was safer and more effective than 5-HT3RAs alone for CINV patients. However, due to the limitations of the included studies, more high-quality clinical trials are required to further validate our findings.
背景
半夏（Pinellia ternata，半夏）为常用的中药，在中国被广泛用于化疗所致恶心呕吐（CINV）的辅助治疗。然而，其疗效和安全性的证据仍然有限。
目的
研究半夏为基础的中药联合 5-羟色胺 3 受体拮抗剂（5-HT3RAs）治疗 CINV 的疗效和安全性。
研究设计
系统评价和随机对照试验（RCT）的荟萃分析。
方法
从 7 个互联网数据库（截至 2023 年 2 月 10 日）系统地检索所有相关的 RCT。所有 RCT 均将半夏为基础的中药联合 5-HT3RAs 治疗 CINV 纳入研究。临床有效率（CER）定义为主要结局，而食欲、生活质量（QOL）和不良反应为次要结局。
结果
荟萃分析纳入了 22 项 RCT，共 1787 名患者。研究结果表明，半夏为基础的中药联合 5-HT3RAs 可显著提高 CINV 的 CER（RR=1.46，95%CI=1.37-1.57，p<0.00001）、食欲（RR=1.77，95%CI=1.42-2.20，p<0.00001）、QOL（RR=7.67，95%CI=1.56-13.78，p=0.01）、几种 5-HT3RA 药物的 CER（RR=1.47，95%CI=1.37-1.57，p<0.00001）和急性及迟发性呕吐（RR=1.23，95%CI=1.12-1.36，p<0.0001），而联合治疗降低了 5-HT3RA 治疗 CINV 所致不良反应的发生率（RR=0.50，95%CI=0.42-0.59，p<0.00001）。
结论
根据本系统评价和荟萃分析的结果，半夏为基础的中药联合 5-HT3RAs 治疗 CINV 患者比单独使用 5-HT3RA 更安全、更有效。然而，由于纳入研究的局限性，需要更多高质量的临床试验来进一步验证我们的发现。
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