中藥治療中晚期非小細(xì)胞肺癌的Meta分析
發(fā)布時(shí)間：2018-07-22 17:27
【摘要】：【目的】通過(guò)Meta分析方法,對(duì)既往相關(guān)文獻(xiàn)進(jìn)行歸納整理,評(píng)價(jià)中藥與一線化療方案對(duì)比治療中晚期非小細(xì)胞肺癌的臨床療效�！痉椒ā坎捎秒娮泳W(wǎng)絡(luò)及手工檢索相互交叉的檢索方式,國(guó)內(nèi)文庫(kù)選用:相關(guān)期刊論文(CNKI,1984-2016.12)、重慶維普數(shù)據(jù)庫(kù)(VIP,1989-2016.12)、萬(wàn)方數(shù)據(jù)庫(kù)(Wanfang,1980-2016.12)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM,1978-2016.12);外文文庫(kù)選用:PubMed(1966-2016.12)、Cochrane Library(1988-2016.12)數(shù)據(jù)庫(kù)隨機(jī)對(duì)照試驗(yàn)的文獻(xiàn)。語(yǔ)言限定為中文、英文。嚴(yán)格按照納入標(biāo)準(zhǔn)與排除標(biāo)準(zhǔn)對(duì)檢索出的文獻(xiàn)進(jìn)行篩選,其結(jié)果運(yùn)用Meta分析常用軟件Review manager5.3進(jìn)行Meta分析,對(duì)納入文獻(xiàn)進(jìn)行Meta分析時(shí),二分類變量使用相對(duì)危險(xiǎn)度RR,時(shí)間-事件變量使用風(fēng)險(xiǎn)比HR,異質(zhì)性檢驗(yàn)采用卡方檢驗(yàn),采用固定或隨機(jī)效應(yīng)模型對(duì)納入研究文獻(xiàn)的結(jié)果進(jìn)行Meta分析。結(jié)局指標(biāo)包括:瘤體總有效率;瘤體穩(wěn)定率;生活質(zhì)量KPS評(píng)分改善率。【搜索結(jié)果】共納入14篇符合納入標(biāo)準(zhǔn)的文獻(xiàn),涉及病例數(shù)總共798例。其中有關(guān)單純中藥對(duì)照一線化療方案治療中晚期非小細(xì)胞肺癌的瘤體總有效率及瘤體穩(wěn)定率的所納入的文獻(xiàn)相同,共13篇文獻(xiàn),涉及病例數(shù)共758例;單純中藥對(duì)照一線化療方案治療中晚期非小細(xì)胞肺癌的生活質(zhì)量KPS評(píng)分改善率的研究共納入7個(gè)篇文獻(xiàn),涉及病例數(shù)共351例�！綧eta分析結(jié)果顯示】1.單純使用中藥較單純使用一線化療方案在治療中晚期非小細(xì)胞肺癌臨床瘤體總有效率方面無(wú)優(yōu)勢(shì)。X2=16.55,df=12,p=0.170.05,I2=28%50%,各個(gè)研究間異質(zhì)性較低,采用固定效應(yīng)模型,結(jié)果顯示:RR=0.50,[95%CI(0.36,0.68)],效應(yīng)量檢驗(yàn)Z=4.36(P0.0001),具有統(tǒng)計(jì)學(xué)意義。2.單純使用中藥較單純使用一線化療方案在治療中晚期非小細(xì)胞肺癌臨床瘤體穩(wěn)定率方面治療效果相近。X2=10.46,df=12,p=0.580.05,I2=050%,各個(gè)研究間異質(zhì)性較低,同質(zhì)性較好,采用固定效應(yīng)模型,結(jié)果顯示:RR=0.99,[95%CI(0.90,1.09)],效應(yīng)量檢驗(yàn)Z=0.15(P=0.880.05),不具有統(tǒng)計(jì)學(xué)意義。3.單純使用中藥較單純使用一線化療方案在生活質(zhì)量KPS評(píng)分改善率方面有較大優(yōu)勢(shì)。X2=3.49,df=6,p=0.740.05,I2=0%50%,各個(gè)研究間異質(zhì)性較低,具有良好的同質(zhì)性,采用固定效應(yīng)模型,結(jié)果顯示:RR=2.53,[95%CI(1.94,3.30)],效應(yīng)量檢驗(yàn)Z=6.38(P0.00001),具有統(tǒng)計(jì)學(xué)意義。納入的14篇文獻(xiàn)均為RCT,其中有6篇文獻(xiàn)提及具體隨機(jī)方式,其余8篇分組方法中僅提及"隨機(jī)"二字,并未對(duì)隨機(jī)方法進(jìn)行具體說(shuō)明,所有研究?jī)H有1篇文獻(xiàn)提及分配隱藏,因此存在一定的選擇性偏倚。所有納入文獻(xiàn)中僅1篇文章提及雙盲法,3篇文獻(xiàn)提及使用單盲法,其余文獻(xiàn)均未提及是否使用盲法,故存在測(cè)量性偏倚和實(shí)施性偏倚等偏倚風(fēng)險(xiǎn)。[結(jié)論]單純中藥相較于單純一線化療方案在治療中晚期非小細(xì)胞肺癌生活質(zhì)量KPS評(píng)分改善率方面有一定的優(yōu)勢(shì),在臨床瘤體穩(wěn)定率方面療效相近,在臨床瘤體總有效率方面無(wú)優(yōu)勢(shì)。
[Abstract]:[objective] to summarize and sort out the related literatures by meta-analysis. To evaluate the clinical efficacy of traditional Chinese medicine and first-line chemotherapy in the treatment of advanced non-small cell lung cancer. The selection of domestic databases: CNKI full text Database (CNKI) 1984-2016.12, Chongqing Weipu Database (VIPB) 1989-2016.12, Wanfang Database 1980-2016.12, Chinese Biomedical Literature Database (CBM1978-2016.12), and Foreign language Database selected the literature of the randomized controlled trial of the Chinese Library Cochrane (1988-2016.12). The language is limited to Chinese and English. According to the inclusion criteria and exclusion criteria, the retrieved documents were screened. The results were analyzed by Meta-analysis software manager5.3. Two classification variables use relative risk RR, time-event variable use risk ratio HR. heterogeneity test is chi-square test, fixed or random effect model is used to conduct Meta-analysis of the results included in the research literature. The outcome indicators included: total effective rate, tumor stability rate, KPS score improvement rate of quality of life. [search results] included 14 articles that met the inclusion criteria, involving a total of 798 cases. Among them, the total effective rate and tumor stability rate of patients with advanced non-small cell lung cancer treated with traditional Chinese medicine alone were the same, 13 articles were involved, and 758 cases were involved. The study on the improvement rate of quality of life (QOL) score in non-small cell lung cancer (NSCLC) treated by traditional Chinese medicine (TCM) with first-line chemotherapy was included in 7 articles, involving 351 cases. [Meta-analysis results] 1. There was no advantage in the total effective rate of treating middle and advanced non-small cell lung cancer with traditional Chinese medicine alone as compared with first-line chemotherapy regimen. The total effective rate of the treatment was 0.170.05 I2T28P.There was no advantage in the total effective rate of treatment of middle and advanced non-small cell lung cancer. The heterogeneity of each study was lower, and the fixed effect model was adopted. The results showed that: RRN 0.50, [95% CI (0.36% 0.68)], the effect quantity test was 4.36 (P 0.0001), which was statistically significant. The clinical stability rate of NSCLC treated by traditional Chinese medicine alone was similar to that of first-line chemotherapy regimen alone. X2O10. 46dfU 12p 0.580.05 I2C0500.The heterogeneity and homogeneity of each study were lower and better. The fixed effect model was used for the treatment of non-small cell lung cancer (NSCLC) in the middle and advanced stage, and the stability of the tumor was similar to that of the first-line chemotherapy regimen in the treatment of advanced non-small cell lung cancer (NSCLC). The results showed that: RRN was 0.99, [95% CI (0.90 鹵1.09)], and the effect quantity test was 0.15 (P0. 880.05), which had no statistical significance. Compared with first-line chemotherapy alone, the improvement rate of KPS score in quality of life (KPS) was better than that of traditional Chinese medicine alone. The improvement rate of KPS score of QOL was better than that of traditional Chinese medicine alone. The improvement rate of KPS score of QOL was better than that of first-line chemotherapy alone. The improvement rate of KPS score was higher than that of first-line chemotherapeutic regimen. The heterogeneity of each study was lower and had good homogeneity. The results showed that: RRN 2.53, [95% CI (1.94 鹵3.30)], the effect quantity test was 6.38 (P0.00001), which had statistical significance. The 14 articles included were all RCTs, of which 6 mentioned specific random methods, the remaining 8 mentioned only the word "random" without specifying the random methods, and only one of the studies mentioned assignment and concealment. Therefore, there is a certain selective bias. Only one article mentioned the double blind method and three mentioned the use of the single blind method in all the literatures, and the others did not mention whether or not to use the blind method. Therefore, there was a risk of bias, such as measurement bias and operational bias. [conclusion] compared with first-line chemotherapy alone, traditional Chinese medicine has some advantages in the improvement rate of KPS score in the treatment of intermediate and advanced non-small cell lung cancer, and the curative effect is similar in the clinical stability rate of non-small cell lung cancer. There is no advantage in the total effective rate of clinical tumor.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2
本文編號(hào)：2138213
[Abstract]:[objective] to summarize and sort out the related literatures by meta-analysis. To evaluate the clinical efficacy of traditional Chinese medicine and first-line chemotherapy in the treatment of advanced non-small cell lung cancer. The selection of domestic databases: CNKI full text Database (CNKI) 1984-2016.12, Chongqing Weipu Database (VIPB) 1989-2016.12, Wanfang Database 1980-2016.12, Chinese Biomedical Literature Database (CBM1978-2016.12), and Foreign language Database selected the literature of the randomized controlled trial of the Chinese Library Cochrane (1988-2016.12). The language is limited to Chinese and English. According to the inclusion criteria and exclusion criteria, the retrieved documents were screened. The results were analyzed by Meta-analysis software manager5.3. Two classification variables use relative risk RR, time-event variable use risk ratio HR. heterogeneity test is chi-square test, fixed or random effect model is used to conduct Meta-analysis of the results included in the research literature. The outcome indicators included: total effective rate, tumor stability rate, KPS score improvement rate of quality of life. [search results] included 14 articles that met the inclusion criteria, involving a total of 798 cases. Among them, the total effective rate and tumor stability rate of patients with advanced non-small cell lung cancer treated with traditional Chinese medicine alone were the same, 13 articles were involved, and 758 cases were involved. The study on the improvement rate of quality of life (QOL) score in non-small cell lung cancer (NSCLC) treated by traditional Chinese medicine (TCM) with first-line chemotherapy was included in 7 articles, involving 351 cases. [Meta-analysis results] 1. There was no advantage in the total effective rate of treating middle and advanced non-small cell lung cancer with traditional Chinese medicine alone as compared with first-line chemotherapy regimen. The total effective rate of the treatment was 0.170.05 I2T28P.There was no advantage in the total effective rate of treatment of middle and advanced non-small cell lung cancer. The heterogeneity of each study was lower, and the fixed effect model was adopted. The results showed that: RRN 0.50, [95% CI (0.36% 0.68)], the effect quantity test was 4.36 (P 0.0001), which was statistically significant. The clinical stability rate of NSCLC treated by traditional Chinese medicine alone was similar to that of first-line chemotherapy regimen alone. X2O10. 46dfU 12p 0.580.05 I2C0500.The heterogeneity and homogeneity of each study were lower and better. The fixed effect model was used for the treatment of non-small cell lung cancer (NSCLC) in the middle and advanced stage, and the stability of the tumor was similar to that of the first-line chemotherapy regimen in the treatment of advanced non-small cell lung cancer (NSCLC). The results showed that: RRN was 0.99, [95% CI (0.90 鹵1.09)], and the effect quantity test was 0.15 (P0. 880.05), which had no statistical significance. Compared with first-line chemotherapy alone, the improvement rate of KPS score in quality of life (KPS) was better than that of traditional Chinese medicine alone. The improvement rate of KPS score of QOL was better than that of traditional Chinese medicine alone. The improvement rate of KPS score of QOL was better than that of first-line chemotherapy alone. The improvement rate of KPS score was higher than that of first-line chemotherapeutic regimen. The heterogeneity of each study was lower and had good homogeneity. The results showed that: RRN 2.53, [95% CI (1.94 鹵3.30)], the effect quantity test was 6.38 (P0.00001), which had statistical significance. The 14 articles included were all RCTs, of which 6 mentioned specific random methods, the remaining 8 mentioned only the word "random" without specifying the random methods, and only one of the studies mentioned assignment and concealment. Therefore, there is a certain selective bias. Only one article mentioned the double blind method and three mentioned the use of the single blind method in all the literatures, and the others did not mention whether or not to use the blind method. Therefore, there was a risk of bias, such as measurement bias and operational bias. [conclusion] compared with first-line chemotherapy alone, traditional Chinese medicine has some advantages in the improvement rate of KPS score in the treatment of intermediate and advanced non-small cell lung cancer, and the curative effect is similar in the clinical stability rate of non-small cell lung cancer. There is no advantage in the total effective rate of clinical tumor.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2
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