保守医学干预作为复杂性区域疼痛综合征治疗中导管介导溶栓的补充：一项随机对照试验的系统评价和荟萃分析
Conservative medical intervention as a complement to CDT for BCRL therapy: a systematic review and meta-analysis of randomized controlled trials.
作者信息
Deng Chuyu, Wu Zhiguo, Cai Zijie, Zheng Xiaoyan, Tang Chunzhi
机构信息
Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China.
出版信息
Front Oncol. 2024 Apr 26;14:1361128. doi: 10.3389/fonc.2024.1361128. eCollection 2024.
BACKGROUND
The effect of first-line complex decongestive therapy (CDT) for breast cancer-related lymphedema (BCRL) depending on various factors forces patients to seek additional treatment. Therefore, this meta-analysis was conducted to evaluate the effect of different conservative medical interventions as a complement to CDT. This is the first meta-analysis that includes various kinds of conservative treatments as adjunctive therapy to get broader knowledge and improve practical application value, which can provide recommendations to further improve BCRL patients' health status.
METHODS
RCTs published before 18 December 2023 from PubMed, Embase, Cochrane Library, and Web of Science databases were searched. RCTs that compared the effects of conservative medical intervention were included. A random-effects or fixed-effects model was used based on the heterogeneity findings. Study quality was evaluated using the Cochrane risk of bias tool.
RESULTS
Sixteen RCTs with 690 participants were included, comparing laser therapy, intermittent pneumatic compression (IPC), extracorporeal shock wave therapy (ESWT), electrotherapy, ultrasound, diet or diet in combination with synbiotic supplement, traditional Chinese medicine (TCM), continuous passive motion (CPM), and negative pressure massage treatment (NMPT). The results revealed that conservative medical intervention as complement to CDT had benefits in improving lymphedema in volume/circumference of the upper extremity [SMD = -0.30, 95% CI = (-0.45, -0.15), < 0.05, 51%], visual analog score (VAS) for pain [SMD = -3.35, 95% CI (-5.37, -1.33), < 0.05, 96%], quality of life [SMD = 0.44, 95% CI (0.19, 0.69), < 0.05, 0], and DASH/QuickDASH [SMD = -0.42, 95% CI (-0.70, -0.14), < 0.05, 10%] compared with the control group. Subgroup analysis revealed that laser therapy and electrotherapy are especially effective ( < 0.05).
CONCLUSION
Combining conservative medical interventions with CDT appears to have a positive effect on certain BCRL symptoms, especially laser therapy and electrotherapy. It showed a better effect on patients under 60 years old, and laser therapy of low to moderate intensity (5-24 mW, 1.5-2 J/cm) and of moderate- to long-term duration (≥36-72 sessions) showed better effects.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=354824, identifier CRD42022354824.
背景
一线综合消肿治疗（CDT）对乳腺癌相关淋巴水肿（BCRL）的疗效受多种因素影响，这使得患者不得不寻求额外的治疗方法。因此，本荟萃分析旨在评估不同保守医学干预措施作为CDT补充治疗的效果。这是第一项将各种保守治疗作为辅助疗法纳入的荟萃分析，目的是获得更广泛的知识并提高实际应用价值，从而为进一步改善BCRL患者的健康状况提供建议。
方法
检索了截至2023年12月18日在PubMed、Embase、Cochrane图书馆和Web of Science数据库中发表的随机对照试验（RCT）。纳入比较保守医学干预效果的RCT。根据异质性结果使用随机效应或固定效应模型。采用Cochrane偏倚风险工具评估研究质量。
结果
纳入了16项RCT，共690名参与者，比较了激光治疗、间歇性气动压迫（IPC）、体外冲击波治疗（ESWT）、电疗法、超声、饮食或饮食联合合生元补充剂、中医（TCM）、持续被动运动（CPM）和负压按摩治疗（NMPT）。结果显示，与对照组相比，作为CDT补充的保守医学干预在改善上肢体积/周长的淋巴水肿方面有显著效果[标准化均数差（SMD）=-0.30，95%置信区间（CI）=（-0.45，-0.15），P<0.05，I²=51%]，在疼痛视觉模拟评分（VAS）方面有显著效果[SMD=-3.35，95%CI（-5.37，-1.33），P<0.05，I²=96%]，在生活质量方面有显著效果[SMD=0.44，95%CI（0.19，0.69），P<0.05，I²=0]，在DASH/QuickDASH方面有显著效果[SMD=-0.42，95%CI（-0.70，-0.14），P<0.05，I²=10%]。亚组分析显示，激光治疗和电疗法尤其有效（P<0.05）。
结论
将保守医学干预与CDT相结合似乎对某些BCRL症状有积极影响，尤其是激光治疗和电疗法。对60岁以下患者效果更好，低至中等强度（5 - 24 mW，1.5 - 2 J/cm）且中等至长期疗程（≥36 - 72次）的激光治疗效果更佳。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=354824，标识符CRD42022354824。
Zotero 插件