發(fā)布時間：2018-07-21 15:29

【摘要】：目的:通過Meta分析的方法,對所收集的原始研究數(shù)據(jù)進(jìn)行分析,綜合評價中醫(yī)藥防治乳腺癌蒽環(huán)藥物化療導(dǎo)致的心臟毒性的療效。材料與方法:以“中醫(yī)藥”“乳腺癌”“蒽環(huán)類藥物”“心臟毒性”“Traditional Chinese Medision”“breast cancer”“Anthracycline drugs”“cardiac toxicity”為關(guān)鍵詞檢索萬方、維普、CNKI、Pubmed數(shù)據(jù)庫。按納入標(biāo)準(zhǔn)篩選文獻(xiàn),采用Review Manager 5.3軟件對文獻(xiàn)進(jìn)行Meta分析,文中所涉及的二分類變量采用相對危險度(risk ratio)以及95%置信區(qū)間(CI)進(jìn)行表示,連續(xù)性變量采用標(biāo)準(zhǔn)均數(shù)差(SMD)表示,各效應(yīng)量采用95%CI表示,分析P值及I2,如P0.1、I2≥50%,則提示各研究間存在異質(zhì)性,采用隨機效應(yīng)模型進(jìn)行分析,反之不存在異質(zhì)性,采用固定效應(yīng)模型分析。觀察漏斗圖對否對稱,從而判斷文章是否存在發(fā)表偏倚。結(jié)果:1.檢索文獻(xiàn)結(jié)果篩選納入18篇關(guān)于中醫(yī)藥防治乳腺癌蒽環(huán)類化療心臟毒性的隨機對照試驗(randomized controlled trials,RCTs),共1998例患者。2.Meta分析結(jié)果Meta分析結(jié)果提示,與對照組相比,試驗組能夠降低心臟損傷的各項指標(biāo),減少LVEF的降低幅度[SMD=1.02,95%CI(0.56,1.48),P0.0001],降低c Tn I、c Tn T的升高幅度[SMD=-3.05,95%CI(-5.63,-0.47),P=0.02],[SMD=-1.36,95%CI(-2.13,-0.58),P=0.0006],降低CK-MB的升高幅度[SMD=-3.90,95%CI(-6.68,-1.11),P=0.006],減少心電圖期前收縮的發(fā)生率[RR=0.46,95%CI(0.31,0.67),P0.0001],降低ST-T段異常的發(fā)生率[RR=0.55,95%CI(0.41,0.73),P0.0001]。結(jié)論:Meta分析結(jié)果顯示,與對照組相比,中藥聯(lián)合蒽環(huán)類化療能夠降低乳腺癌蒽環(huán)類化療藥物產(chǎn)生的心臟毒性,且在左室射血分?jǐn)?shù)、肌鈣蛋白、CK-MB及心電圖等指標(biāo)上均表現(xiàn)出顯著療效,故推薦臨床應(yīng)用。
[Abstract]:Objective: to analyze the original data collected by Meta analysis, and to evaluate the efficacy of traditional Chinese medicine on the prevention and treatment of cardiac toxicity caused by anthracycline chemotherapy in breast cancer. Materials and methods: "Chinese medicine" "breast cancer" "anthracycline" "heart toxicity" "Traditional Chinese Medision" "breast can "Cer" "Anthracycline drugs" "cardiac toxicity" for keyword retrieval of Wanfang, VP, CNKI, Pubmed database. According to the inclusion criteria, the literature is selected by Review Manager 5.3 software for Meta analysis. The two classified variables involved in this article are represented by relative risk degree (risk ratio) and 95% confidence interval. The continuity variable is expressed by standard mean difference (SMD), and the effect quantity is expressed by 95%CI. The analysis of P and I2, such as P0.1, I2 > 50%, indicates the existence of heterogeneity in each study, and the random effect model is used to analyze it, and on the contrary, there is no heterogeneity, and a fixed effect model is used to analyze whether the funnel map is symmetrical or not, so as to judge whether the article exists or not. Results: 1. retrieval literature results were selected to include 18 randomized controlled trials (randomized controlled trials, RCTs) for the prevention and control of the heart toxicity of anthracycline chemotherapy in breast cancer. A total of 1998 patients with.2.Meta analysis showed that the results of Meta analysis were compared with the control group, and the experimental group could reduce the indexes of heart damage. Reduce the amplitude of [SMD=1.02,95%CI (0.56,1.48), P0.0001], reduce C Tn I, C Tn T increase amplitude [SMD=-3.05,95%CI. P0.0001], reducing the incidence of ST-T segment abnormalities [RR=0.55,95%CI (0.41,0.73), P0.0001]. conclusion: Meta analysis showed that the combination of Chinese medicine and anthracycline chemotherapy, compared with the control group, could reduce the cardiac toxicity of anthracycline chemotherapy drugs in breast cancer, and showed significant differences in left ventricular ejection fraction, troponin, CK-MB, and electrocardiogram. As a result, clinical application is recommended.
【學(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.9

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