中藥對(duì)AIs、TAM治療乳腺癌的不良反應(yīng)的干預(yù)效果系統(tǒng)評(píng)價(jià)
發(fā)布時(shí)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(píng)價(jià)中藥對(duì)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(kù)的特點(diǎn),和文獻(xiàn)的納入排除標(biāo)準(zhǔn),設(shè)計(jì)出合理有效的文獻(xiàn)檢索策略。應(yīng)用計(jì)算機(jī)檢索Cochrane圖書(shū)館、PubMed,EM Base、中國(guó)知識(shí)資源總庫(kù)(CNKI)、萬(wàn)方數(shù)據(jù)庫(kù)、維普數(shù)據(jù)庫(kù),收集中醫(yī)藥聯(lián)合AIs及TAM藥物治療乳腺癌的隨機(jī)對(duì)照試驗(yàn),檢索時(shí)限為從建庫(kù)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(píng)價(jià)。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(duì)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(yàn)Z=4.15,P0.0001,差異顯著,有統(tǒng)計(jì)學(xué)性意義;對(duì)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(yàn)Z=2.68,P=0.0070.01,差異顯著,有統(tǒng)計(jì)學(xué)性意義;對(duì)改良kupperman評(píng)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(yàn)Z=11.44,P0.00001,差異有顯著意義;對(duì)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(yàn)Z=0.02,P=0.990.05,表明用藥前后無(wú)差異,漏斗圖不對(duì)稱(chēng),存在發(fā)表偏倚的可能;對(duì)卡氏評(píng)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(yàn)Z=4.65,P=0.00001,差異顯著,有統(tǒng)計(jì)學(xué)意義;對(duì)外周血CD4~+計(jì)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(yàn)Z=2.58,P=0.010.05,差異有統(tǒng)計(jì)學(xué)意義;對(duì)外周血CD8~+計(jì)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(yàn)Z=7.75,P0.00001,差異顯著,有統(tǒng)計(jì)學(xué)意義;對(duì)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(yàn)Z=7.88,P0.00001,差異顯著,有統(tǒng)計(jì)學(xué)意義;對(duì)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(yàn)Z=1.38,P=0.170.05,表明用藥前后無(wú)差異;對(duì)血清總膽固醇的系統(tǒng)評(píng)價(jià):仍需納入更多文獻(xiàn);對(duì)CA153的影響系統(tǒng)評(píng)價(jià):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(píng)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(duì)FSH有影響;配合AIs、TAM內(nèi)分泌藥治療乳腺癌,未證明對(duì)E2有影響;配合TAM治療乳腺癌較單純使用TAM,患者KPS評(píng)分更高;配合AIs、TAM內(nèi)分泌藥治療乳腺癌,CD4~+計(jì)數(shù)更高;輔助AIs、TAM治療乳腺癌,CD8~+計(jì)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(duì)CA125產(chǎn)生影響。對(duì)血清膽固醇、CA153、中藥不良反應(yīng)的評(píng)價(jià),尚需要納入基線一致、質(zhì)量更高的文獻(xiàn)進(jìn)行評(píng)價(jià)。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(shí)驗(yàn)室指標(biāo)更輕,免疫細(xì)胞計(jì)數(shù)更優(yōu),未證明對(duì)E2、FSH有影響。但有待納入大樣本、高質(zhì)量的隨機(jī)對(duì)照試驗(yàn)進(jìn)行更嚴(yán)謹(jǐn)?shù)南到y(tǒng)評(píng)價(jià),下一步應(yīng)對(duì)個(gè)體患者的臨床重要改變進(jìn)行評(píng)估,對(duì)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(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R273
本文編號(hào)：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(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R273
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