中藥對AIs、TAM治療乳腺癌的不良反應(yīng)的干預(yù)效果系統(tǒng)評價
發(fā)布時間：2018-07-18 14:58
【摘要】：目的立足于循證醫(yī)學(xué),根據(jù)Cochrane協(xié)作網(wǎng)的方法,評價中藥對AIs及TAM治療乳腺癌所致不良反應(yīng)的干預(yù)作用,為使用中藥干預(yù)AIs、TAM治療乳腺癌的不良反應(yīng)提供參考依據(jù)。方法根據(jù)Cochrane協(xié)作網(wǎng)的方法,以及各數(shù)據(jù)庫的特點,和文獻(xiàn)的納入排除標(biāo)準(zhǔn),設(shè)計出合理有效的文獻(xiàn)檢索策略。應(yīng)用計算機(jī)檢索Cochrane圖書館、PubMed,EM Base、中國知識資源總庫(CNKI)、萬方數(shù)據(jù)庫、維普數(shù)據(jù)庫,收集中醫(yī)藥聯(lián)合AIs及TAM藥物治療乳腺癌的隨機(jī)對照試驗,檢索時限為從建庫至2017年2月,檢索截止日期為2017年2月1日,提取相關(guān)資料,應(yīng)用RevMan5.3軟件進(jìn)行Met a分析及定性的系統(tǒng)評價。結(jié)果共檢索到1498篇文獻(xiàn),最終納入全文文獻(xiàn)24篇,全部為中文文獻(xiàn)。對腰椎骨密度BMD的影響Meta分析:合并MD值為0.09,95%可信區(qū)間CI為[0.05,0.13],整體效果檢驗Z=4.15,P0.0001,差異顯著,有統(tǒng)計學(xué)性意義;對子宮內(nèi)膜厚度的Meta分析:合并MD值為-0.94,95%可信區(qū)間CI為[-1.63,-0.25],整體效果檢驗Z=2.68,P=0.0070.01,差異顯著,有統(tǒng)計學(xué)性意義;對改良kupperman評分的Meta分析:合并MD值為-16.13,95%可信區(qū)間CI為[-18.89,-13.36],整體效果檢驗Z=11.44,P0.00001,差異有顯著意義;對血清E2的Meta分析:合并SMD值為0.00,95%可信區(qū)間CI為[-0.25,0.26],整體效果檢驗Z=0.02,P=0.990.05,表明用藥前后無差異,漏斗圖不對稱,存在發(fā)表偏倚的可能;對卡氏評分的Meta分析:合并SMD值為5.00,95%可信區(qū)間CI為[2.89,7.11],整體效果檢驗Z=4.65,P=0.00001,差異顯著,有統(tǒng)計學(xué)意義;對外周血CD4~+計數(shù)的Meta分析:合并MD值為3.18,95%可信區(qū)間CI為[0.77,5.60],整體效果檢驗Z=2.58,P=0.010.05,差異有統(tǒng)計學(xué)意義;對外周血CD8~+計數(shù)的Meta分析:合并MD值為-2.73,95%可信區(qū)間CI為[-3.42,-2.04],整體效果檢驗Z=7.75,P0.00001,差異顯著,有統(tǒng)計學(xué)意義;對外周血CD4~+/CD8~+的Meta分析:合并MD值為0.27,95%可信區(qū)間CI為[0.20,0.33],整體效果檢驗Z=7.88,P0.00001,差異顯著,有統(tǒng)計學(xué)意義;對CA125的Meta分析:合并MD值為-1.56,95%可信區(qū)間CI為[-3.78,0.66],整體效果檢驗Z=1.38,P=0.170.05,表明用藥前后無差異;對血清總膽固醇的系統(tǒng)評價:仍需納入更多文獻(xiàn);對CA153的影響系統(tǒng)評價:指向指向中藥干預(yù)下CA153有所降低,仍需更多大樣本、高質(zhì)量研究支持;未證明中藥配合AI、TAM產(chǎn)生不良反應(yīng),仍需納入更多文獻(xiàn)。結(jié)論中藥配合TAM治療乳腺癌較單純使用TAM相比,患者kupperman評分更低;配合AIs藥物治療乳腺癌較不使用中藥相比,患者的BMD更高;配合TAM治療乳腺癌較單純使用TAM相比,子宮內(nèi)膜厚度更薄;配合TAM治療乳腺癌,未證明中藥對FSH有影響;配合AIs、TAM內(nèi)分泌藥治療乳腺癌,未證明對E2有影響;配合TAM治療乳腺癌較單純使用TAM,患者KPS評分更高;配合AIs、TAM內(nèi)分泌藥治療乳腺癌,CD4~+計數(shù)更高;輔助AIs、TAM治療乳腺癌,CD8~+計數(shù)更低;配合AIs、TAM內(nèi)分泌藥治療乳腺癌,CD4~+/CD8~+比值更低;輔助AIs、TAM治療乳腺癌,未證明對CA125產(chǎn)生影響。對血清膽固醇、CA153、中藥不良反應(yīng)的評價,尚需要納入基線一致、質(zhì)量更高的文獻(xiàn)進(jìn)行評價。使用中藥配合AIs、TAM治療乳腺癌,較不使用中藥相比,部分不良反應(yīng)的癥狀及實驗室指標(biāo)更輕,免疫細(xì)胞計數(shù)更優(yōu),未證明對E2、FSH有影響。但有待納入大樣本、高質(zhì)量的隨機(jī)對照試驗進(jìn)行更嚴(yán)謹(jǐn)?shù)南到y(tǒng)評價,下一步應(yīng)對個體患者的臨床重要改變進(jìn)行評估,對中醫(yī)證型進(jìn)行分組分析。
[Abstract]:Objective based on evidence-based medicine and based on the method of Cochrane cooperation network, the intervention effect of traditional Chinese medicine on the adverse reactions caused by AIs and TAM in the treatment of breast cancer was evaluated, and the reference basis was provided for the use of traditional Chinese medicine to interfere with AIs and TAM in the treatment of breast cancer, according to the formula of the Cochrane cooperation network, the characteristics of each database, and the inclusion of the literature. In addition to the standard, a reasonable and effective literature retrieval strategy is designed. Using computer to retrieve Cochrane library, PubMed, EM Base, Chinese general library of knowledge resources (CNKI), Wanfang database, VP database, a randomized controlled trial of combining traditional Chinese medicine with AIs and TAM drugs in the treatment of breast cancer, the retrieval time limit is from the construction to the February 2017, the search cut-off day In February 1, 2017, the relevant data were extracted and RevMan5.3 software was used to perform Met a analysis and qualitative systematic evaluation. Results a total of 1498 articles were retrieved and 24 articles were included in the full text literature. All of them were Chinese literature. The effect of Meta analysis on the BMD of lumbar bone mineral density: the combined MD value of 0.09,95% confidence interval CI was [0.05,0.13], and the overall effect was tested Z. =4.15, P0.0001, significant difference, statistically significant; Meta analysis of endometrial thickness: MD value is -0.94,95% confidence interval CI [-1.63, -0.25], the overall effect of Z=2.68, P=0.0070.01, significant difference, and statistically significant; 3.36], the overall effect test Z=11.44, P0.00001, the difference is significant; the Meta analysis of serum E2: the combined SMD value of 0.00,95% confidence interval CI is [-0.25,0.26], the overall effect test Z=0.02, P=0.990.05, indicates that there is no difference between the drugs before and after the drug use, the funnel plot asymmetry, the possibility of the bias of the hair table; the Meta analysis of the card score: the combined value of 5 0,95% confidence interval CI is [2.89,7.11], the overall effect test Z=4.65, P=0.00001, significant difference, statistically significant; Meta analysis of CD4~+ count in peripheral blood: MD value is 3.18,95% confidence interval CI [0.77,5.60], the whole effect test Z=2.58, the difference has the significance of unified planning; The -2.73,95% confidence interval CI is [-3.42, -2.04], the overall effect test Z=7.75, P0.00001, significant difference, statistically significant; the Meta analysis of the peripheral blood CD4~+/CD8~+: the MD value is 0.27,95% confidence interval CI [0.20,0.33]. -1.56,95% confidence interval CI is [-3.78,0.66], the overall effect test Z=1.38, P=0.170.05, show no difference before and after drug use; the systematic evaluation of serum total cholesterol: still need to include more literature; evaluation of the influence of CA153: pointing to the intervention of Chinese medicine intervention CA153 has decreased, still need more large samples, high quality research support; Chinese traditional medicine is not proved. It is still necessary to incorporate more literature with AI and TAM. Conclusion the Kupperman score of the patients with breast cancer with TAM is lower than that of TAM alone, and the BMD is higher in the patients with breast cancer than that of the traditional Chinese medicine. The endometrial thickness is thinner compared with the simple use of TAM in the treatment of breast cancer with TAM. TAM treatment of breast cancer has not proved that traditional Chinese medicine has an impact on FSH, and with AIs, TAM endocrine drugs are not proved to have an impact on E2, and that with TAM for breast cancer more than pure TAM and higher KPS score; with AIs, TAM endocrinology for breast cancer, CD4~+ count; adjuvant AIs, breast cancer, lower count Endocrine drugs in the treatment of breast cancer, CD4~+/CD8~+ ratio is lower; adjuvant AIs, TAM treatment of breast cancer, not proved to have an impact on CA125. Serum cholesterol, CA153, the evaluation of adverse effects of traditional Chinese medicine, still need to be included in the baseline, higher quality of the literature to evaluate. The use of traditional Chinese medicine with AIs, TAM for breast cancer, compared with the use of traditional Chinese medicine, compared with the use of traditional Chinese medicine, part of comparison, comparison of traditional Chinese medicine, part of the use of traditional Chinese medicine, comparison, comparison, comparison, comparison of traditional Chinese medicine, comparison, comparison, comparison of traditional Chinese medicine, comparison of some compared with traditional Chinese medicine, comparison of the use of traditional Chinese medicine, comparison, comparison, comparison of the use of traditional Chinese medicine, comparison, comparison, comparison of the use of traditional Chinese medicine, comparison, comparison, comparison of the use of traditional Chinese medicine, comparison, comparison, comparison of the use of traditional Chinese medicine, The symptoms and laboratory indicators of adverse reactions were lighter, the immune cell count was better, and the E2 and FSH had not been proved to be affected. However, the large sample was included, the high quality randomized controlled trial carried out a more rigorous systematic evaluation, the next step should be to evaluate the important clinical changes of the individual patients and analyze the TCM Syndrome Types in groups.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R273
本文編號：2132264
[Abstract]:Objective based on evidence-based medicine and based on the method of Cochrane cooperation network, the intervention effect of traditional Chinese medicine on the adverse reactions caused by AIs and TAM in the treatment of breast cancer was evaluated, and the reference basis was provided for the use of traditional Chinese medicine to interfere with AIs and TAM in the treatment of breast cancer, according to the formula of the Cochrane cooperation network, the characteristics of each database, and the inclusion of the literature. In addition to the standard, a reasonable and effective literature retrieval strategy is designed. Using computer to retrieve Cochrane library, PubMed, EM Base, Chinese general library of knowledge resources (CNKI), Wanfang database, VP database, a randomized controlled trial of combining traditional Chinese medicine with AIs and TAM drugs in the treatment of breast cancer, the retrieval time limit is from the construction to the February 2017, the search cut-off day In February 1, 2017, the relevant data were extracted and RevMan5.3 software was used to perform Met a analysis and qualitative systematic evaluation. Results a total of 1498 articles were retrieved and 24 articles were included in the full text literature. All of them were Chinese literature. The effect of Meta analysis on the BMD of lumbar bone mineral density: the combined MD value of 0.09,95% confidence interval CI was [0.05,0.13], and the overall effect was tested Z. =4.15, P0.0001, significant difference, statistically significant; Meta analysis of endometrial thickness: MD value is -0.94,95% confidence interval CI [-1.63, -0.25], the overall effect of Z=2.68, P=0.0070.01, significant difference, and statistically significant; 3.36], the overall effect test Z=11.44, P0.00001, the difference is significant; the Meta analysis of serum E2: the combined SMD value of 0.00,95% confidence interval CI is [-0.25,0.26], the overall effect test Z=0.02, P=0.990.05, indicates that there is no difference between the drugs before and after the drug use, the funnel plot asymmetry, the possibility of the bias of the hair table; the Meta analysis of the card score: the combined value of 5 0,95% confidence interval CI is [2.89,7.11], the overall effect test Z=4.65, P=0.00001, significant difference, statistically significant; Meta analysis of CD4~+ count in peripheral blood: MD value is 3.18,95% confidence interval CI [0.77,5.60], the whole effect test Z=2.58, the difference has the significance of unified planning; The -2.73,95% confidence interval CI is [-3.42, -2.04], the overall effect test Z=7.75, P0.00001, significant difference, statistically significant; the Meta analysis of the peripheral blood CD4~+/CD8~+: the MD value is 0.27,95% confidence interval CI [0.20,0.33]. -1.56,95% confidence interval CI is [-3.78,0.66], the overall effect test Z=1.38, P=0.170.05, show no difference before and after drug use; the systematic evaluation of serum total cholesterol: still need to include more literature; evaluation of the influence of CA153: pointing to the intervention of Chinese medicine intervention CA153 has decreased, still need more large samples, high quality research support; Chinese traditional medicine is not proved. It is still necessary to incorporate more literature with AI and TAM. Conclusion the Kupperman score of the patients with breast cancer with TAM is lower than that of TAM alone, and the BMD is higher in the patients with breast cancer than that of the traditional Chinese medicine. The endometrial thickness is thinner compared with the simple use of TAM in the treatment of breast cancer with TAM. TAM treatment of breast cancer has not proved that traditional Chinese medicine has an impact on FSH, and with AIs, TAM endocrine drugs are not proved to have an impact on E2, and that with TAM for breast cancer more than pure TAM and higher KPS score; with AIs, TAM endocrinology for breast cancer, CD4~+ count; adjuvant AIs, breast cancer, lower count Endocrine drugs in the treatment of breast cancer, CD4~+/CD8~+ ratio is lower; adjuvant AIs, TAM treatment of breast cancer, not proved to have an impact on CA125. Serum cholesterol, CA153, the evaluation of adverse effects of traditional Chinese medicine, still need to be included in the baseline, higher quality of the literature to evaluate. The use of traditional Chinese medicine with AIs, TAM for breast cancer, compared with the use of traditional Chinese medicine, compared with the use of traditional Chinese medicine, part of comparison, comparison of traditional Chinese medicine, part of the use of traditional Chinese medicine, comparison, comparison, comparison, comparison of traditional Chinese medicine, comparison, comparison, comparison of traditional Chinese medicine, comparison of some compared with traditional Chinese medicine, comparison of the use of traditional Chinese medicine, comparison, comparison, comparison of the use of traditional Chinese medicine, comparison, comparison, comparison of the use of traditional Chinese medicine, comparison, comparison, comparison of the use of traditional Chinese medicine, comparison, comparison, comparison of the use of traditional Chinese medicine, The symptoms and laboratory indicators of adverse reactions were lighter, the immune cell count was better, and the E2 and FSH had not been proved to be affected. However, the large sample was included, the high quality randomized controlled trial carried out a more rigorous systematic evaluation, the next step should be to evaluate the important clinical changes of the individual patients and analyze the TCM Syndrome Types in groups.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R273
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 楊慧芬;羅華;楊歐歐;胡祖健;何俊玲;徐海濱;;二至丸合桂枝湯對絕經(jīng)前Luminal型乳腺癌內(nèi)分泌治療患者5-羥色胺及抑制素B水平的影響[J];新中醫(yī);2016年12期
2 袁博;胡金輝;周亮;楊爭;;補(bǔ)腎活血湯對乳腺癌患者芳香化酶抑制劑治療后骨量減少的影響[J];中醫(yī)藥導(dǎo)報;2016年21期
3 鹿曉君;;雙黃益骨方對芳香化酶抑制劑致乳腺癌患者骨量丟失骨代謝的影響[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2016年32期
4 盧海松;王祥麒;姬衛(wèi)國;王俊濤;;消更散治療抗雌激素藥物所致乳腺癌患者類更年期綜合征[J];中醫(yī)學(xué)報;2016年04期
5 王蘭;王彬彬;;吳良村治療乳腺癌內(nèi)分泌治療后經(jīng)驗總結(jié)[J];陜西中醫(yī)藥大學(xué)學(xué)報;2016年01期
6 李關(guān)寧;楊振淮;楊俊杰;;荔枝核皂苷在乳腺癌術(shù)后內(nèi)分泌治療中的臨床應(yīng)用[J];現(xiàn)代醫(yī)院;2015年12期
7 富琦;張青;趙文碩;;郁仁存應(yīng)用六味地黃湯加減治療乳腺癌經(jīng)驗[J];北京中醫(yī)藥;2015年11期
8 付烊;運(yùn)強(qiáng);朱學(xué)明;;黑逍遙散聯(lián)合腎四味對他莫昔芬治療乳腺癌所致類更年期癥狀患者臨床指標(biāo)及生活質(zhì)量的影響研究[J];癌癥進(jìn)展;2015年05期
9 許娟;曾文;朱彩霞;連臻強(qiáng);陳鳳媚;;六味地黃丸預(yù)防乳腺癌芳香化酶抑制劑治療相關(guān)骨丟失的研究[J];中國婦幼保健;2014年33期
10 施云福;韋巧玲;周麗娜;;益元生精湯治療乳腺癌三苯氧胺治療后類更年期綜合征的臨床觀察[J];浙江中醫(yī)藥大學(xué)學(xué)報;2014年10期
相關(guān)會議論文 前1條
1 馮佳梅;萬華;;脾腎同治法對乳腺癌術(shù)后內(nèi)分泌治療副作用的影響[A];第十二次全國中醫(yī)、中西醫(yī)結(jié)合乳房病學(xué)術(shù)會議論文集[C];2011年
相關(guān)博士學(xué)位論文 前2條
1 關(guān)玉娟;乳巖寧與三苯氧胺聯(lián)合抗乳腺癌作用及其機(jī)制的研究[D];遼寧中醫(yī)藥大學(xué);2011年
2 黃梅;三七聯(lián)合三苯氧胺治療乳腺癌臨床及實驗研究[D];廣州中醫(yī)藥大學(xué);2011年
相關(guān)碩士學(xué)位論文 前8條
1 謝楠嵐;益腎沉潛方對乳腺癌內(nèi)分泌治療期他莫昔芬副作用干預(yù)的臨床研究[D];南京中醫(yī)藥大學(xué);2014年
2 譚桂蘭;補(bǔ)腎法對應(yīng)用芳香化酶抑制劑的腎虛型乳腺癌患者的影響[D];廣州中醫(yī)藥大學(xué);2014年
3 黃水才;荔枝核對絕經(jīng)后乳腺癌內(nèi)分泌治療患者雌激素水平的影響[D];廣州中醫(yī)藥大學(xué);2013年
4 陳麗芝;調(diào)和飲對ER（+）、PR（+）、HER-2（-）乳腺癌三苯氧胺治療患者骨密度的影響[D];黑龍江中醫(yī)藥大學(xué);2012年
5 喻璐;補(bǔ)腎法對絕經(jīng)后芳香化酶抑制劑治療乳腺癌患者雌激素水平的影響[D];廣州中醫(yī)藥大學(xué);2012年
6 孫少梅;滋水清肝飲對模擬乳腺癌內(nèi)分泌治療不良反應(yīng)作用的實驗研究[D];南京中醫(yī)藥大學(xué);2012年
7 趙怡;補(bǔ)腎法對乳腺癌芳香化酶抑制劑相關(guān)骨丟失的臨床觀察[D];廣州中醫(yī)藥大學(xué);2011年
8 時百玲;補(bǔ)腎法對乳腺癌芳香化酶抑制劑所致骨丟失的影響[D];廣州中醫(yī)藥大學(xué);2010年
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