中药治疗恶性肿瘤患者放射性肺损伤的疗效及安全性的Meta分析

林贤雷 林泽晨 钟亚珍 陆金华 林胜友

[关键词] 中药;放射性肺炎;放射性肺损伤;肿瘤;Meta分析

[中图分类号] R734.2          [文献标识码] B          [文章编号] 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

放射性肺損伤（Radiation induced lung injury，RILI）为胸部放射治疗过程中一个不可避免的并发症，是影响肿瘤靶区剂量乃至局控率的主要因素之一，主要表现为急性期的放射性肺炎及慢性期的放射性肺纤维化。放射性纤维化是胸部肿瘤放疗后最严重的并发症，严重影响患者的生活质量，缩短生存时间[1]。根据中医基础理论，肺为娇脏，放射线属热毒，热毒直中肺脏，灼伤肺阴，炼津成痰;毒邪内壅，耗气伤血;迁延不愈则痰瘀互结，阻滞肺络，导致肺纤维化发生。基于中医对肺脏病理生理的认识，结合临床放射性肺纤维化的病机演变过程，以清热解毒、养阴生津、化痰祛瘀法指导的治疗方案或新药开发成为放射性肺损伤治疗最为活跃的领域。目前有大量实验研究以及临床试验证实，中药治疗放射性肺损伤不但能提高西药临床治疗有效率，还能改善患者生活质量，减轻西药治疗过程中产生的一系列副反应。由于对此类研究缺乏多中心、大样本的研究，故本研究应用近期发表的临床对照随机试验，进行Meta分析，探讨中医药在放射性肺损伤中的疗效，为临床使用中医药治疗放射性肺损伤提供依据。