中藥治療惡性腫瘤患者放射性肺損傷的療效及安全性的Meta分析

林賢雷 林澤晨 鐘亞珍 陸金華 林勝友

[關(guān)鍵詞] 中藥;放射性肺炎;放射性肺損傷;腫瘤;Meta分析

[中圖分類號(hào)] R734.2? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] B? ? ? ? ? [文章編號(hào)] 1673-9701（2021）25-0133-07

Meta-analysis of efficacy and safety of traditional Chinese medicine in treatment of radiation lung injury in patients with malignant tumors

LIN Xianlei1? ?LIN Zechen1? ?ZHONG Yazhen1? ?LU Jinhua1? ?LIN Shengyou2

1.Department of Oncology， Hangzhou Hospital of Traditional Chinese Medicine， Hangzhou? 310053， China;2.Office of Administration， Hangzhou Traditional Chinese Medicine Hospital， Hangzhou? 310053， China

[Abstract] Objective To evaluate the therapeutic effect of traditional Chinese medicine on radiation pneumonia in patients with tumors using systematic reviews. Methods Chinese and English databases，including Pubmed，Cochrane Library，Embase，CNKI and Wanfang，were searched from January 1， 2015 to July 30，2020 Revman 5.0 software was used to evaluate the methodological quality of the included studies and the efficacy of the main indicators of radiation pneumonia. The auxiliary indicators included the quality of life，cytokine levels， and adverse events. Results A total of 56 studies were included， with a total of 3983 patients. Compared with the control group， the use of traditional Chinese medicine effectively treated radiation pneumonia [OR=0.32， 95%CI（0.27， 0.39）， P<0.001]， improved the patients quality of life [OR=-7.82，95%CI （-9.64，-6.01）， P<0.001]， increased the patients′ transforming growth factor-β （TGF-β） level [SMD=1.17， 95%CI （0.47， 1.87）， P=0.001]，and reduced the side effects of medication treatment [OR=2.4， 95%CI （1.63， 3.53）， P<0.0001].Subgroup analysis showed that the treatment effect was not related to the combination use of hormones， use of proprietary Chinese medicine injections， and total duration of medication. Conclusion Traditional Chinese medicine can improve the symptoms and imaging examinations of patients with radiation pneumonia， improve the quality of life of patients， and reduce the side effects of medication treatment.

[Key words] Traditional Chinese medicine; Radiation pneumonia; Radiation lung injury; Tumor; Meta-analysis

放射性肺損傷（Radiation induced lung injury，RILI）為胸部放射治療過程中一個(gè)不可避免的并發(fā)癥，是影響腫瘤靶區(qū)劑量乃至局控率的主要因素之一，主要表現(xiàn)為急性期的放射性肺炎及慢性期的放射性肺纖維化。放射性纖維化是胸部腫瘤放療后最嚴(yán)重的并發(fā)癥，嚴(yán)重影響患者的生活質(zhì)量，縮短生存時(shí)間[1]。根據(jù)中醫(yī)基礎(chǔ)理論，肺為嬌臟，放射線屬熱毒，熱毒直中肺臟，灼傷肺陰，煉津成痰;毒邪內(nèi)壅，耗氣傷血;遷延不愈則痰瘀互結(jié)，阻滯肺絡(luò)，導(dǎo)致肺纖維化發(fā)生。基于中醫(yī)對(duì)肺臟病理生理的認(rèn)識(shí)，結(jié)合臨床放射性肺纖維化的病機(jī)演變過程，以清熱解毒、養(yǎng)陰生津、化痰祛瘀法指導(dǎo)的治療方案或新藥開發(fā)成為放射性肺損傷治療最為活躍的領(lǐng)域。目前有大量實(shí)驗(yàn)研究以及臨床試驗(yàn)證實(shí)，中藥治療放射性肺損傷不但能提高西藥臨床治療有效率，還能改善患者生活質(zhì)量，減輕西藥治療過程中產(chǎn)生的一系列副反應(yīng)。由于對(duì)此類研究缺乏多中心、大樣本的研究，故本研究應(yīng)用近期發(fā)表的臨床對(duì)照隨機(jī)試驗(yàn)，進(jìn)行Meta分析，探討中醫(yī)藥在放射性肺損傷中的療效，為臨床使用中醫(yī)藥治療放射性肺損傷提供依據(jù)。