中药提取物及制剂降低多柔比星心脏不良反应疗效的Meta分析  

Meta-analysis of Efficacy of Chinese Herbal Extracts and Preparations in Reducing Cardiotoxicity of Doxorubicin

作　　者：王继婷 李亚玲 田塬 唐贵菊 陈洪燕 WANG Jiting;LI Yaling;TIAN Yuan;TANG Guiju;CHEN Hongyan(Department of Clinical Pharmacy,School of Pharmacy,Southwest Medical University,Luzhou 646000,Sichuan,China;Department of Pharmacy,Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China)

机构地区：[1]西南医科大学药学院临床药学系,四川泸州646000 [2]西南医科大学附属医院药学部,四川泸州646000

出　　处：《辽宁中医杂志》2021年第2期26-32,共7页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(81803019)。

摘　　要：目的系统评价不同中药提取物及制剂降低化疗药物多柔比星所致心脏不良反应的临床疗效。方法计算机检索PubMed、Embase、Web of Science、Cochrane图书馆、中国知网、万方和维普数据库,检索时限为数据库建库至2019年8月。筛选研究中药提取物及制剂降低DOX治疗多种癌症所致心脏不良反应疗效的临床随机对照试验,采用Review Manager 5.2和Stata 14.0进行Meta分析。结果纳入11篇RCT,总计854例患者。在疗效指标方面,黄芪注射液观察组和对照组心脏毒性发生率无差别(RR=0.31,95%CI 0.09~1.03,P=0.057),舒血宁注射液和红花注射液观察组和对照组心电图异常发生率无差别(分别为RR=0.44,95%CI 0.15~1.33,P=0146;RR=0.41,95%CI 0.16~1.04,P=0.059),其他中药提取物及制剂的观察组心脏毒性、心电图异常发生率均低于对照组(合并值分别为RR=0.24,95%CI 0.13~0.44,P<0.000 01;RR=0.35,,95%CI 0.29~0.44,P<0.000 01);治疗前所有观察组的ck-mb、cTNI和对照组无显著差别(分别为RR=-0.19,95%CI-0.39~-0.00,P=0.047;RR=-0.25,95%CI-0.44~-0.06,P=0.011),治疗后所有观察组的ck-mb、cTNI值均显著低于对照组(分别为RR=-3.19,95%CI-3.49~-2.90,P<0.00001;RR=-2.76,95%CI-3.04~-2.48,P<0.00001);所有观察组LVIDD值、LVISD值显著小于对照组(分别为RR=-1.8,95%CI-2.05~-1.55,P<0.00001;RR=-1.11,95%CI-1.43~-0.89,P<0.00001);所有观察组FS值均高于对照组(RR=0.55,95%CI 0.35~0.75,P<0.00001)。结论除舒血宁注射液、红花注射液、黄芪注射液、银杏叶提取物在个别疗效指标中的效果不理想,纳入的11项研究在所有指标中总体对降低多柔比星心脏不良反应有效。Objective To systematically evaluate the clinical efficacy of different extracts and preparations of traditional Chinese medicine in reducing cardiac toxicity caused by chemotherapy drug doxorubicin.Methods PubMed,Embase,Web of Science,Cochrane Library,China HowNet,Wanfang and Weipu databases were searched by computer.The searching time was until August 2019.A randomized controlled clinical trial was conducted to study the efficacy of Chinese herbal extracts and preparations in reducing cardiac toxicity of DOX in the treatment of multiple cancers.Meta-analysis was conducted using Review Manager 5.2 and Stata 14.0.Results A total of 11 RCTs were included,including 854 patients.There was no difference in the incidence of cardiac toxicity between the observation group and the control group of Astragalus Injection(RR=0.31,95%CI 0.09-1.03,P=0.057).There was no difference in the incidence of abnormal ECG between the observation group and the control group of Shuxuening Injection and Safflower Injection(RR=0.44,95%CI 0.15-1.33,P=0146;RR=0.41,95% CI 0.16-1.0,P=0.059).The incidence of cardiac toxicity and electrocardiogram abnormalities in the observation group of other traditional Chinese medicine extracts and preparations was lower than those in the control group(the combined values were RR=0.24,95%CI 0.13-0.44,P<0.00001;RR=0.35,95%CI 0.29-0.44,P<0.00001)and there was no significant difference in CK-MB or cTNIbetween the observation group and the control group before treatment(RR=-0.19,95%CI-0.39--0.00,P=0.047;RR=-0.25,95%CI-0.44--0.06,P=0.011).After treatment,levels of CK-MB and cTNI of all the observation groups were significantly lower than those of the control group(RR=-3.19,95%CI-3.49--2.90,P<0.00001;RR=-2.76,95%CI-3.04--2.48,P<0.00001).The levels of LVIDD and LVISD of all the observation groups were significantly lower than those of the control group(RR=-1.8,95%CI-2.05--1.55,P<0.00001;RR=-1.11,95%CI-1.43--0.89,P<0.00001).The FS values of the observation group were higher than those of the control group(RR=0.55,95%

关 键 词：中药 多柔比星 阿霉素 心脏不良反应 疗效 META分析 

分 类 号：R256.2[医药卫生—中医内科学]