中医药对肿瘤蒽环类化疗导致心脏毒性保护作用的meta分析  

A systematic review and meta-analysis on the protective effect of combined TCM and Western medicine on cardiotoxicity induced by anthracycline chemotherapy

作　　者：刘璨 邢雁伟[1] 苏鑫 刘旭[2] LIU Can;XING Yan‐Wei;SU Xin;LIU Xu(Guanganmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]中国中医科学院广安门医院,北京100053 [2]北京中医药大学,北京100029

出　　处：《海南医学院学报》2022年第5期377-389,共13页Journal of Hainan Medical University

基　　金：国家重点研发计划资助(2018YFC1704901)。

摘　　要：目的:系统评价中医药对肿瘤蒽环类化疗导致心脏毒性保护作用的疗效,为临床提供指导。方法:计算机检索中国知网数据库(CNKI)、中国生物医学文献检索(SinoMed)、万方数据知识服务系统(WanFang Data)、维普全文数据库(VIP)、PubMed、MedLine、cochrane library,搜集有关中医药治疗肿瘤蒽环类化疗导致心脏毒性的随机对照试验(RCT),由2位研究人员筛查从建库至2020年12月1日的文献,提取所需指标,并纳入RevMan5.4分析。纳入的RCT依据Cochrane手册进行偏倚风险评估。结果:纳入37项RCT,共计2844名患者。Meta分析结果显示,治疗组与对照组相比较,中医药治疗能减轻蒽环类化疗药降低左心室射血分数[WMD=6.44,95%CI(0.38~12.50),P=0.04],增大左心室收缩末期内径[WMD=-0.47,95%CI(-0.60~-0.34),P<0.00001]和左心室舒张末期内径[WMD=-0.59,95%CI(-0.74~-0.44),P<0.00001]的作用,并降低蒽环类药物升高肌钙蛋白I[WMD=-0.19,95%CI(-0.23~-0.16),P<0.00001]、肌钙蛋白T[WMD=-0.02,95%CI(-0.03~-0.01),P<0.00001]和脑钠肽[WMD=-32.21,95%CI(-58.21~-6.22),P=0.02]等心肌损伤物的作用,差异具有统计学意义。结论:目前现有证据可以证明中医药在对肿瘤蒽环类化疗导致心脏毒性方面具有保护作用,维持左室射血分数和心室直径,控制心肌损伤标志物水平,减轻心脏损伤。Objective:To systematically evaluate the therapeutic effect of TCM on cardiotoxicity induced by anthracycline chemotherapy to provide clinical guidance.Methods:China hownet database(CNKI),Chinese biomedical literature retrieval(SinoMed),ten thousand Data knowledge service system(WanFang Data),VIP full-text database(VIP),PubMed,MedLine and the cochrane library were searched from inception to 1 st,December,2020.Relevant combined TCM and Western medicine on cardiotoxicity randomized controlled trials(RCT)were collected.The risk of bias in included RCTs were evaluated according to the Cochrane Handbook.The required indicators were extracted and included in RevMan5.4 analysis.Results:A total of 2844 patients were included in 37 RCTS.The results of meta-analysis showed that compared with the control group,TCM treatment group could alleviate the effect of anthracycline on ventricular ejection function,reduce the effect of anthracycline chemotherapy drugs in lowering left ventricular ejection fraction(WMD=6.44,95%CI 0.38 to 12.50,P=0.04),reduce the effect of anthracycline chemotherapy in increasing left ventricular end diastolic diameter(WMD=-0.59,95%CI-0.74 to-0.44,P<0.00001),reduce the effect of anthracycline chemotherapy drugs in increasing left ventricular end systolic diameter(WMD=-0.47,95%CI-0.60 to-0.34,P<0.00001),and reduce the effect of anthracyclines on troponin I(WMD=-0.19,95%CI-0.23 to-0.16,P<0.00001)、troponin T(WMD=-0.02,95%CI-0.03 to-0.01,P<0.00001)and brain natriuretic peptide(WMD=-32.21,95%CI-58.21 to-6.22,P=0.02).Conclusion:The existing evidence can prove that TCM has a protective effect on cardiotoxicity caused by anthracycline chemotherapy,maintaining left ventricular ejection fraction and ventricular diameter,controlling the level of myocardial injury markers,and alleviating cardiac injury.

关 键 词：中医药 肿瘤心脏病 心脏毒性 META分析 随机对照试验 

分 类 号：R273[医药卫生—中西医结合]