中藥復方聯合放射療法治療鼻咽癌療效的Meta分析_《華西醫學》

作者：

喬蓓 ^1,2 , 袁維利 ¹ , 張穎 ¹ , 馮敏 ³ , 錢瑛 ³ , 鄒林玲 ³ ,  張瑞明 ¹

1 四川大學華西醫院中西醫結合科（成都，610041）;2 西藏大學醫學院臨床醫學系;3 四川大學華西醫院臨床藥理基地?GCP中心;

關鍵詞：

鼻咽癌放射治療中醫藥益氣養陰清熱活血隨機對照試驗 Meta分析

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【摘要】　目的　評價中藥復方（益氣養陰、清熱活血方Yiqi Yangyin Qingre Huoxue decoction，YYQHD）聯合放射療法治療鼻咽癌在減毒增效方面的療效。　方法　采用Cochrane系統評價方法，電子檢索Cochrane圖書館臨床對照試驗資料庫（Cochrane Central Register of Controlled Trials，CENTRAL）、PubMed、EMBASE、中國生物醫學文獻數據庫（CBM）、中文科技期刊全文數據庫（CNKI）和中國期刊全文數據庫（VIP）以及萬方數據庫等數據庫2010年3月前所發表的相關文獻。同時互聯網檢索Current Controlled Trial、Clinical Trials和中國臨床試驗注冊網。手工檢索部分腫瘤類核心期刊。采用Cochrane協作網推薦的 “偏倚風險評估”工具，評估納入研究的質量，使用RevMan 5.0.23.0軟件對納入的研究進行定量系統評價。　結果　最終納入符合標準的中文文獻9篇共795例患者。定量分析結果顯示:與單純常規放射治療相比較，中藥復方（YYQHD）聯合常規放射治療能顯著提高腫瘤近期療效、生存率，并且能顯著減少放射治療常見毒副反應的發生，從而提高放射治療按時完成率確保放射治療療效、改善患者生存質量。　結論　雖現有研究尚不能得出可以將中藥復方（YYQHD）作為標準治療手段輔助放射治療的結論，但提示益氣養陰、清熱活血類中藥聯合放射治療治療鼻咽癌是值得繼續探索的研究方向，期待設計科學合理、高質量的多中心、大樣本、雙盲、隨機對照臨床試驗以進一步驗證其療效。
【Abstract】　Objective　 To compare the efficacy of traditional Chinese medicine (TCM) plus radiotherapy (RT) with RT alone on nasopharyngeal carcinoma (NPC) by Yiqi Yangyin Qingre Huoxue decoction (YYQHD) through a meta-analysis of all available randomized controlled trials.　Methods　 Literature retrieval was conducted using the Cochrane Library, PubMed, EMBASE, CBMdisk, CNKI, VIP, and Wanfang Database electronically. Relevant journals and conference proceedings were also hand-searched until March 31, 2010. The quality of included studies was assessed according to the criteria recommended by the Cochrane handbook, and the Meta-analysis was performed for homogeneous studies using RevMan 5.0.23.0 Software.　Results　 Basing on our search criteria, we found nine trials (795 patients) which all published in Chinese. Our results showed that TCM (YYQHD) plus RT compared with RT alone, improved immediate tumor response, survival, completion rate of RT, quality of life, and alleviation of adverse effect of patients with NPC.　Conclusions　 Considering the limitations related to this Meta-analysis, it nevertheless presents credible evidence that TCM (YYQHD) plus RT is worthy of additional study. Therefore, further large-scale, muti-center, randomized, and double-blind trials are warranted.

引用本文： 喬蓓,袁維利,張穎,馮敏,錢瑛,鄒林玲,張瑞明. 中藥復方聯合放射療法治療鼻咽癌療效的Meta分析. 華西醫學, 2011, 26(3): 391-398. doi: 復制

1.	Boyle P, Levin B. World Cancer Report 2008[M]. Lyon: International Agency for Research on Cancer, 2008: 380-384.
2.	Jia WH, Huang QH, Liao J, et al. Trends in incidence and mortality of nasopharyngeal carcinoma over a 20-25 year period (1978/1983-2002) in Sihui and Cangwu counties in southern China[J]. BMC Cancer, 2006, 6(1-8): 178.
3.	Lee AW, Foo W, Mang O, et al. Changing epidemiology of nasopharyngeal carcinoma in Hong Kong over a 20-year period (1980-99): an encouraging reduction in both incidence and mortality[J]. Int J Cancer, 2003, 103(5): 680-685.
4.	Wei WI, Sham JS. Nasopharyngeal carcinoma[J]. Lancet, 2005, 365(9476): 2041-2054.
5.	NCCN頭頸部腫瘤臨床實踐指南(中國版)2010年[M/OL]. http: //www. nccn-asia. org/cn/Adaptation.aspx? Cator ID=51&KoID=13&Opsition=2010.
6.	周小軍, 田道法. 鼻咽癌古文獻研究[J]. 中華醫史雜志, 2001, 31(4): 115-118.
7.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions[M]. Version5. 0. 2. [updated September 2009]. http: //www. cochrane-handbook. org/.
8.	徐伯平, 胡丕麗, 陳勇, 等. 養陰清熱方防治急性放射性反應的研究[J]. 癌癥, 1999, 18(4): 457-464.
9.	王炳勝, 劉秀芳, 王濤, 等. 活血益氣養陰方防治急性放射損傷的研究[J]. 中國中西醫結合雜志, 2000, 20(3): 180-182.
10.	劉城林, 劉健雄, 劉麗萍, 等. 養陰活血方對鼻咽癌放療減毒增效的臨床觀察[J]. 中國中西醫結合雜志, 2002, 22(12): 918-920.
11.	文先惠, 劉嘉, 伍偉景. 益氣養陰化瘀解毒法配合放射治療復發性鼻咽癌65例總結[J]. 中國醫師雜志, 2003, 5(5): 712-714.
12.	張紅. 導赤散加味配合放療治療鼻咽癌40例[J]. 湖南中醫學院學報, 2003, 23(2): 34-35.
13.	金紅, 吳湘瑋. 養陰解毒法減低鼻咽癌放射反應24例療效觀察[J]. 山東中醫雜志, 2005, 24(1): 17-19.
14.	張支農, 張劍, 陳紅云, 等. 中西醫結合治療晚期鼻咽癌46例總結[J]. 湖南中醫雜志, 2006, 22(1): 1-2.
15.	袁國榮, 盧麗琴, 欽志泉, 等. 加味清營湯對鼻咽癌放療增效減毒的臨床研究[J]. 中醫藥學刊, 2006, 24(4): 670-671.
16.	何福根, 陳曉鐘, 章紅燕. 養陰生津協定方改善鼻咽癌患者放療毒副反應59例療效觀察[J]. 福建中醫藥, 2008, 39(5): 13-14.
17.	Trotti A, Bellm LA, Epstein JB, et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review[J]. Radiother Oncol, 2003, 66(3): 253-262.
18.	McQuestion M. Evidence-based skin care management in radiation therapy[J]. Semin Oncol Nurs, 2006, 22(3): 163-173.
19.	Fang FM, Chiu HC, Kuo WR, et al. Health-related quality of life for nasopharyngeal carcinoma patients with cancer-free survival after treatment[J]. Int J Radiat Oncol Biol Phys, 2002, 53(4): 959-968.
20.	Pajak TF, Laramore GE, Marcial VA, et al. Elapsed treatment days-a critical item for radiotherapy quality control review in head and neck trials: RTOG report[J]. Int J Radiat Oncol Biol Phys, 1991, 20(1): 13-20.
21.	Thomas J, Beinhorn C, Norton D, et al. Managing radiation therapy side effect with complementary medicine[J]. J Soc Integr Oncol, 2010, 8(2): 65-80.
22.	Hsiao WL, Liu L. The role of traditional Chinese herbal medicines in cancer therapy-from TCM therapy to mechanistic insights[J]. Planta Med, 2010, 76(11): 1118-1131.
23.	Li QF, Shi SL, Liu QR, et al. Anticancer effects of ginsenoside Rg1, cinnamic acid, and tanshinoneⅡA in osteosarcoma MG-63 cells: nuclear matrix downregulation and cytoplasmic trafficking of nucleophosmin[J]. Int J Biochem Cell Biol, 2008, 40(9): 1918-1929.
24.	Chen LZ, Feng XW, Zhou JH. Effect of rehmannia glutinosa polysaccharide b on T-lymphocytes in mice bearing sarcoma 180[J]. Acta Pharmacol Sin, 1995, 16(4): 337-340.
25.	Cho WC, Leung KN. In vitro and in vivo anti-tumor effects of astragalus membranaceus[J]. Cancer Lett, 2007, 252(1): 43-54.
26.	Gupta S, Zhang D, Yi J, et al. Anticancer activities of oldenlandia diffusa[J]. J Herb Pharmacother, 2004, 4(1): 21-33.
27.	Chu Q, Satoh K, Kanamoto T, et al. Antitumor potential of three herbal extracts against human oral squamous cell lines[J]. Anticancer Res, 2009, 29(8): 3211-3219.
28.	Xie CH, Zhang MS, Zhou YF, et al. Chinese medicine angelica sinensis suppresses radiation-induced expression of TNF-alpha and TGF-betal in mice[J]. Oncol Rep, 2006, 15(6): 1429-1436.
29.	Hui MK, Wu WK, Shin VY, et al. Polysaccharides from the root of angelica sinensis protect bone marrow and gastrointestinal tissues against the cytotoxicity of cyclophosphamide in mice[J]. Int J Med Sci, 2006, 3(1): 1-6.
30.	Bao YX, Wong CK, Leung SF, et al. Clinical studies of immunomodulatory activities of yunzhi-danshen in patients with nasopharyngeal carcinoma[J]. J Alter Complement Med, 2006, 12(8): 771-776.
31.	Dai AW, Li ZY, Wang LH, et al. Effect of yangyin humo decoction on oral mucomembranous reaction to radiotherapy[J]. Chin J Integr Med, 2009, 15(4): 303-306.
32.	陳俏妍, 夏紀嚴, 韓凌, 等. 滋陰清熱法防治陰虛內熱證急性放射性口腔炎臨床研究[J]. 中國中西醫結合雜志, 2010, 30(7): 694-698.
33.	李廷謙, 劉雪梅, 張鳴明, 等. 中文期刊發表的中醫藥系統評價/Meta分析現狀調查[J]. 中國循證醫學雜志, 2007, 7(3): 180-188.
34.	吳泰相, 李幼平, 卞兆祥, 等. 中醫藥臨床隨機對照試驗報告規范(征求意見稿) [J]. 中國循證醫學雜志, 2007, 7(8): 601-605.
35.	胡丹, 康德英, 洪旗. 中醫藥系統評價中的異質性分析與處理[J]. 中國循證醫學雜志, 2010, 10(4): 488-491.
36.	Wang G, Mao B, Xiong ZY, et al. The quality of reporting of randomized controlled trials of traditional Chinese medicine: a survey of 13 randomly selected journals from mainland China[J]. Clin Ther, 2007, 29(7): 1456-1467.
37.	Hewitt C, Hahn S, Torgerson DJ, et al. Adequacy and reporting of allocation concealment: review of recent trials published in four general medical journals[J]. BMJ, 2005, 330 (7499): 1057-1058.
38.	Llorca J, Martinez-Sanz F, Prieto-Salceda D, et al. Quality of controlled clinical trials on glaucoma and intraocular high pressure[J]. J Glaucoma, 2005, 14(3): 190-195.

1. 　Boyle P, Levin B. World Cancer Report 2008[M]. Lyon: International Agency for Research on Cancer, 2008: 380-384.
2. 　Jia WH, Huang QH, Liao J, et al. Trends in incidence and mortality of nasopharyngeal carcinoma over a 20-25 year period (1978/1983-2002) in Sihui and Cangwu counties in southern China[J]. BMC Cancer, 2006, 6(1-8): 178.
3. 　Lee AW, Foo W, Mang O, et al. Changing epidemiology of nasopharyngeal carcinoma in Hong Kong over a 20-year period (1980-99): an encouraging reduction in both incidence and mortality[J]. Int J Cancer, 2003, 103(5): 680-685.
4. 　Wei WI, Sham JS. Nasopharyngeal carcinoma[J]. Lancet, 2005, 365(9476): 2041-2054.
5. 　NCCN頭頸部腫瘤臨床實踐指南(中國版)2010年[M/OL]. http: //www. nccn-asia. org/cn/Adaptation.aspx? Cator ID=51&KoID=13&Opsition=2010.
6. 　周小軍, 田道法. 鼻咽癌古文獻研究[J]. 中華醫史雜志, 2001, 31(4): 115-118.
7. 　Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions[M]. Version5. 0. 2. [updated September 2009]. http: //www. cochrane-handbook. org/.
8. 　徐伯平, 胡丕麗, 陳勇, 等. 養陰清熱方防治急性放射性反應的研究[J]. 癌癥, 1999, 18(4): 457-464.
9. 　王炳勝, 劉秀芳, 王濤, 等. 活血益氣養陰方防治急性放射損傷的研究[J]. 中國中西醫結合雜志, 2000, 20(3): 180-182.
10. 　劉城林, 劉健雄, 劉麗萍, 等. 養陰活血方對鼻咽癌放療減毒增效的臨床觀察[J]. 中國中西醫結合雜志, 2002, 22(12): 918-920.
11. 　文先惠, 劉嘉, 伍偉景. 益氣養陰化瘀解毒法配合放射治療復發性鼻咽癌65例總結[J]. 中國醫師雜志, 2003, 5(5): 712-714.
12. 　張紅. 導赤散加味配合放療治療鼻咽癌40例[J]. 湖南中醫學院學報, 2003, 23(2): 34-35.
13. 　金紅, 吳湘瑋. 養陰解毒法減低鼻咽癌放射反應24例療效觀察[J]. 山東中醫雜志, 2005, 24(1): 17-19.
14. 　張支農, 張劍, 陳紅云, 等. 中西醫結合治療晚期鼻咽癌46例總結[J]. 湖南中醫雜志, 2006, 22(1): 1-2.
15. 　袁國榮, 盧麗琴, 欽志泉, 等. 加味清營湯對鼻咽癌放療增效減毒的臨床研究[J]. 中醫藥學刊, 2006, 24(4): 670-671.
16. 　何福根, 陳曉鐘, 章紅燕. 養陰生津協定方改善鼻咽癌患者放療毒副反應59例療效觀察[J]. 福建中醫藥, 2008, 39(5): 13-14.
17. 　Trotti A, Bellm LA, Epstein JB, et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review[J]. Radiother Oncol, 2003, 66(3): 253-262.
18. 　McQuestion M. Evidence-based skin care management in radiation therapy[J]. Semin Oncol Nurs, 2006, 22(3): 163-173.
19. 　Fang FM, Chiu HC, Kuo WR, et al. Health-related quality of life for nasopharyngeal carcinoma patients with cancer-free survival after treatment[J]. Int J Radiat Oncol Biol Phys, 2002, 53(4): 959-968.
20. 　Pajak TF, Laramore GE, Marcial VA, et al. Elapsed treatment days-a critical item for radiotherapy quality control review in head and neck trials: RTOG report[J]. Int J Radiat Oncol Biol Phys, 1991, 20(1): 13-20.
21. 　Thomas J, Beinhorn C, Norton D, et al. Managing radiation therapy side effect with complementary medicine[J]. J Soc Integr Oncol, 2010, 8(2): 65-80.
22. 　Hsiao WL, Liu L. The role of traditional Chinese herbal medicines in cancer therapy-from TCM therapy to mechanistic insights[J]. Planta Med, 2010, 76(11): 1118-1131.
23. 　Li QF, Shi SL, Liu QR, et al. Anticancer effects of ginsenoside Rg1, cinnamic acid, and tanshinoneⅡA in osteosarcoma MG-63 cells: nuclear matrix downregulation and cytoplasmic trafficking of nucleophosmin[J]. Int J Biochem Cell Biol, 2008, 40(9): 1918-1929.
24. 　Chen LZ, Feng XW, Zhou JH. Effect of rehmannia glutinosa polysaccharide b on T-lymphocytes in mice bearing sarcoma 180[J]. Acta Pharmacol Sin, 1995, 16(4): 337-340.
25. 　Cho WC, Leung KN. In vitro and in vivo anti-tumor effects of astragalus membranaceus[J]. Cancer Lett, 2007, 252(1): 43-54.
26. 　Gupta S, Zhang D, Yi J, et al. Anticancer activities of oldenlandia diffusa[J]. J Herb Pharmacother, 2004, 4(1): 21-33.
27. 　Chu Q, Satoh K, Kanamoto T, et al. Antitumor potential of three herbal extracts against human oral squamous cell lines[J]. Anticancer Res, 2009, 29(8): 3211-3219.
28. 　Xie CH, Zhang MS, Zhou YF, et al. Chinese medicine angelica sinensis suppresses radiation-induced expression of TNF-alpha and TGF-betal in mice[J]. Oncol Rep, 2006, 15(6): 1429-1436.
29. 　Hui MK, Wu WK, Shin VY, et al. Polysaccharides from the root of angelica sinensis protect bone marrow and gastrointestinal tissues against the cytotoxicity of cyclophosphamide in mice[J]. Int J Med Sci, 2006, 3(1): 1-6.
30. 　Bao YX, Wong CK, Leung SF, et al. Clinical studies of immunomodulatory activities of yunzhi-danshen in patients with nasopharyngeal carcinoma[J]. J Alter Complement Med, 2006, 12(8): 771-776.
31. 　Dai AW, Li ZY, Wang LH, et al. Effect of yangyin humo decoction on oral mucomembranous reaction to radiotherapy[J]. Chin J Integr Med, 2009, 15(4): 303-306.
32. 　陳俏妍, 夏紀嚴, 韓凌, 等. 滋陰清熱法防治陰虛內熱證急性放射性口腔炎臨床研究[J]. 中國中西醫結合雜志, 2010, 30(7): 694-698.
33. 　李廷謙, 劉雪梅, 張鳴明, 等. 中文期刊發表的中醫藥系統評價/Meta分析現狀調查[J]. 中國循證醫學雜志, 2007, 7(3): 180-188.
34. 　吳泰相, 李幼平, 卞兆祥, 等. 中醫藥臨床隨機對照試驗報告規范(征求意見稿) [J]. 中國循證醫學雜志, 2007, 7(8): 601-605.
35. 　胡丹, 康德英, 洪旗. 中醫藥系統評價中的異質性分析與處理[J]. 中國循證醫學雜志, 2010, 10(4): 488-491.
36. 　Wang G, Mao B, Xiong ZY, et al. The quality of reporting of randomized controlled trials of traditional Chinese medicine: a survey of 13 randomly selected journals from mainland China[J]. Clin Ther, 2007, 29(7): 1456-1467.
37. 　Hewitt C, Hahn S, Torgerson DJ, et al. Adequacy and reporting of allocation concealment: review of recent trials published in four general medical journals[J]. BMJ, 2005, 330 (7499): 1057-1058.
38. 　Llorca J, Martinez-Sanz F, Prieto-Salceda D, et al. Quality of controlled clinical trials on glaucoma and intraocular high pressure[J]. J Glaucoma, 2005, 14(3): 190-195.

《華西醫學》

中藥復方聯合放射療法治療鼻咽癌療效的Meta分析

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《華西醫學》

中藥復方聯合放射療法治療鼻咽癌療效的Meta分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料