经肝动脉灌注榄香烯乳剂联合经肝动脉化疗栓塞术治疗原发性肝癌疗效及安全性的Meta分析  

Meta-analysis of the Efficacy and Safety of Transhepatic Arterial Perfusion of Elemenum Emulsion Combined with Transcatheter Arterial Chemoembolization in the Treatment of Primary Hepatic Carcinoma

作　　者：杨子媚 刘蒙 林尚明 刘林华 魏春山[2] 贺劲松[2] YANG Zi-Mei;LIU Meng;LIN Shang-Ming;LIU Lin-Hua;WEI Chun-Shan;HE Jing-Song(The Fourth Clinical Medical School of Guangzhou University of Chinese Medicine,Shenzhen 518033 Guangdong,China;Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033 Guangdong,China)

机构地区：[1]广州中医药大学第四临床医学院,广东深圳518033 [2]深圳市中医院,广东深圳518033

出　　处：《广州中医药大学学报》2022年第11期2701-2708,共8页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(编号:82074384);广州中医药大学2021年度研究生科研创新项目(编号:A1-2606-21-429-001Z60)。

摘　　要：【目的】系统评价经肝动脉灌注榄香烯乳剂联合经肝动脉化疗栓塞术(TACE)治疗原发性肝癌的疗效及安全性。【方法】检索国内外主要数据库中有关经肝动脉灌注榄香烯乳剂联合TACE(试验组)对比单纯TACE(对照组)治疗中晚期原发性肝癌的随机对照试验(RCTs)。运用Cochrane协作网推荐的偏倚风险评估工具进行文献质量评价,采用RevMan 5.4进行Meta分析。【结果】共纳入12项RCTs,涉及635例患者。Meta分析结果显示,试验组的近期疗效[RR=1.41,95%CI(1.21,1.63),P<0.00001]及在减少术后骨髓抑制发生率[RR=0.76,95%CI(0.59,0.97),P=0.03]方面均优于对照组;1年生存率[RR=1.57,95%CI(1.00,2.45),P=0.05]与对照组比较,差异倾向于有统计学意义;两组半年生存率[RR=1.21,95%CI(0.99,1.48),P=0.07]及术后不良反应包括发热[RR=0.78,95%CI(0.58,1.05),P=0.10]、胃肠道反应[RR=0.96,95%CI(0.74,1.24),P=0.73]、恶心呕吐[RR=0.91,95%CI(0.74,1.11),P=0.34]、腹痛[RR=0.94,95%CI(0.78,1.15),P=0.56]等的发生率比较,差异均无统计学意义。【结论】经肝动脉灌注榄香烯乳剂联合TACE治疗中晚期原发性肝癌能改善近期疗效,减少术后骨髓抑制发生率,但因本研究纳入文献数量较少、质量偏低,结论仍需大样本、多中心的随机双盲临床实验进一步验证。Objective To evaluate the efficacy and safety of transphepatic arterial perfusion of elemenum emulsion combined with transcatheter arterial chemoembolization(TACE)in treating primary hepatic carcinoma(PHC).Methods Randomized controlled trials(RCTs)of transphepatic arterial perfusion of elemenum emulsion combined with TACE(trial group)versus TACE alone(control group)for the treatment of moderate to advanced PHC were retrieved from the major domestic and international databases.Literature quality assessment was performed by using the risk of bias assessment tool recommended by the Cochrane Collaboration Network,and meta-analysis was performed by using RevMan 5.4.Results A total of 12 RCTs were included,involving 635 patients.Meta-analysis showed that the trial group was superior to the control group in terms of short-term efficacy[RR=1.41,95%CI(1.21,1.63),P<0.00001]and in reducing the incidence of postoperative myelosuppression[RR=0.76,95%CI(0.59,0.97),P=0.03].In the trial group,one-year survival rate[RR=1.57,95%CI(1.00,2.45),P=0.05]tended to be statistically significant compared to the control group.The comparison of six-month survival rate[RR=1.21,95%CI(0.99,1.48),P=0.07]and the incidence of postoperative adverse effects such as fever[RR=0.78,95%CI(0.58,1.05),P=0.10],gastrointestinal reactions[RR=0.96,95%CI(0.74,1.24),P=0.73],nausea and vomiting[RR=0.91,95%CI(0.74,1.11),P=0.34],and abdominal pain[RR=0.94,95%CI(0.78,1.15),P=0.56]showed that the differences were not statistically significant.Conclusion Transphepatic arterial perfusion of elemenum emulsion combined with TACE can enhance the short-term efficacy and reduce the incidence of postoperative myelosuppression in treating moderate to advanced PHC.However,due to the small amount and low quality of relevant literature of the included studies,the conclusion still needs to be further verified by large sample-size and multi-center randomized double-blind clinical trials.

关 键 词：榄香烯乳剂 经肝动脉灌注 经肝动脉化疗栓塞术(TACE) 原发性肝癌 近期疗效 骨髓抑制 META分析 

分 类 号：R273.57[医药卫生—中西医结合]