中药对息肉切除术后大肠腺瘤复发的影响：一项系统评价和荟萃分析
Effects of Chinese herbal medicine on colorectal adenoma recurrence following polypectomy: a systematic review and meta-analysis.
作者信息
Cheng Yi, Di Yuan Ming, May Brian, Zhang Anthony Lin, Xue Charlie Changli, Zhang Beiping
机构信息
The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Melbourne, VIC, Australia.
Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong, China.
出版信息
Front Pharmacol. 2025 Mar 20;16:1460900. doi: 10.3389/fphar.2025.1460900. eCollection 2025.
OBJECTIVE
Preventing colorectal adenoma (CRA) recurrence after polypectomy is essential. However, the current evidence of Chinese herbal medicine (CHM) for CRA recurrence is still limited. This study aims to synthesize the effects of CHM as a prevention method for CRA recurrence.
METHODS
Nine databases were searched up to May 2024. Randomised controlled trials identifying the preventive effects of CHM among people with CRA post-polypectomy were included. spreadsheets were used to collect and extract data. RevMan and STATA were used for data analysis. We performed subgroup and sensitivity analyses to explore potentially influencing variables.
RESULTS
Twenty trials (2,325 participants) were included. The commonly used botanical drugs belonged to the categories of strengthening the spleen and anti-tumour metabolites. Compared to routine care (RC) alone, oral CHM plus RC significantly reduced the CRA recurrence rate at 12 months (RR 0.51, 95% CI [0.39, 0.67], I = 42%), 6 months (RR 0.44, 95% CI [0.36, 0.55], I = 0%), and 3 months (RR 0.46, 95% CI [0.22, 0.96], I = 0%) post-polypectomy. Compared to CHM placebo plus RC, granule combined with RC significantly reduced CRA recurrence at 12 months post-polypectomy (RR 0.39, 95% CI [0.16, 0.93], I = 0%) and during the 2-year follow-up (RR 0.73, 95% CI [0.58, 0.90]). There were no significant differences between groups for treatment duration and syndromes. Additional analysis showed that oral CHM containing the botanical drugs of decoction plus RC reduced CRA recurrence at 12 months post-polypectomy with a low heterogeneity, compared to RC alone (RR 0.26, 95% CI [0.13, 0.54], I = 0%). Adverse events were similar in the above two comparisons.
CONCLUSION
Oral CHM combined with RC may reduce CRA recurrence and be well-tolerated. granule and decoction may be representative prescriptions Experimental studies of the frequent botanical drugs have found anti-cancer effects that may account for the clinical findings. Future rigorous clinical trials are needed due to low-to-moderate certainty of evidence.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (CRD42023324197), https://www.crd.york.ac.uk/PROSPERO/view/CRD42023324197.
目的
预防大肠腺瘤（CRA）息肉切除术后复发至关重要。然而，目前关于中药（CHM）预防CRA复发的证据仍然有限。本研究旨在综合评估中药作为预防CRA复发方法的效果。
方法
检索截至2024年5月的九个数据库。纳入确定中药对CRA息肉切除术后患者预防作用的随机对照试验。使用电子表格收集和提取数据。采用RevMan和STATA进行数据分析。我们进行了亚组分析和敏感性分析，以探索潜在的影响变量。
结果
纳入20项试验（2325名参与者）。常用的植物药属于健脾类和抗肿瘤代谢物类。与单纯常规护理（RC）相比，口服中药加RC在息肉切除术后12个月（RR 0.51，95%CI[0.39，0.67]，I² = 42%）、6个月（RR 0.44，95%CI[0.36，0.55]，I² = 0%）和3个月（RR 0.46，95%CI[0.22，0.96]，I² = 0%）时显著降低了CRA复发率。与中药安慰剂加RC相比，颗粒剂联合RC在息肉切除术后12个月（RR 0.39，95%CI[0.16，0.93]，I² = 0%）和2年随访期间（RR 0.73，95%CI[0.58，0.90]）显著降低了CRA复发率。治疗持续时间和证型在组间无显著差异。额外分析表明，与单纯RC相比，口服含汤剂植物药的中药在息肉切除术后12个月时降低CRA复发率，异质性较低（RR 0.26，95%CI[0.13，0.54]，I² = 0%）。上述两种比较中的不良事件相似。
结论
口服中药联合RC可能降低CRA复发率，且耐受性良好。颗粒剂和汤剂可能是代表性方剂。对常用植物药的实验研究发现了抗癌作用，这可能解释了临床结果。由于证据的确定性为低到中等，未来需要进行严格的临床试验。
系统评价注册
PROSPERO（CRD42023324197），https://www.crd.york.ac.uk/PROSPERO/view/CRD42023324197 。
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