系统评价和荟萃分析:中草药外治化疗所致周围神经病变

2022-04-07 August MedSci原创

化疗引起的周围神经病变(CIPN)是化疗常见的不良反应。许多研究证实,中医药(TCM)治疗CIPN具有独特的优势。但在临床实践中没有标准的中医处方,也没有客观的疗效指标,类似的疗效也不尽相同。

化疗引起的周围神经病变(CIPN)是指化疗药物直接损伤周围神经系统导致的四肢感觉或运动障碍。目前CIPN常通过减少化疗药物剂量或停止治疗来缓解,严重影响治疗效果和患者生活质量。但目前尚无针对 CIPN 的特异性西医治疗方法。经常使用神经性疼痛管理和营养补充剂,但疗效不佳。因此,确定有效的 CIPN 治疗方法至关重要。作为一种传统的中药(TCM)疗法,中草药(CHM)在改善临床症状、提高化疗疗效、减少其副作用等方面具有独特的优势。研究系统评价中药外治CIPN的临床疗效,旨在为中药外治CIPN提供更高质量的临床证据和指导。

文献鉴定和筛选流程图

方法:在中国国家知识基础数据库、中国生物医学光盘、中国科技期刊数据库、万方数据库、PubMed、Cochrane图书馆、MEDLINE、Web of Science等9个电子数据库中检索评估CHM外治CIPN的相关RCTs和 OVID,从开始到 2021 年 7 月。使用 RevMan5.3 软件对这些研究进行了荟萃分析。

纳入文献的基本信息

结果:根据纳入和排除标准,纳入临床研究33项,筛选出1354项研究。共有2356例患者,其中治疗组1208例,对照组1148例。治疗组周围神经毒性发生率、总有效率、KPS评分、中医证候评分及疗效、疼痛NRS评分、疼痛缓解率均较对照组显着提高(p <0.01)。此外,与对照组相比,腓骨和正中神经传导速度也有所提高(p< 0.05)。通过绘制外周神经毒性发生率和总有效率的漏斗图,发现左右两侧对称,发表偏倚低。

CIPN以肢体疼痛和麻木为特征,中医称之为“痹证”。化疗药物属于中医“毒邪”;这相当于抗癌中药,很容易破坏人体的正气。此外,癌症患者精气不足,气血不足,痰凝血瘀。因此,治疗的基本原则应以补气、补血、活血、通络为主

CHM 外部和内部治疗显示出相似的功效,但具有不同的特征。CHM外治法以经络理论为基础,可加强药物经皮肤向体内的渗透。在纳入的33项研究中,桂枝是最常用的中药,其次是黄芪和红花,这与CIPN以往“益气活血化瘀温阳通络”的治疗原则是一致的。

综上所述,中医药治疗CIPN通过降低周围神经毒性的发生率、减轻临床症状、提高生活质量等方面具有预防和控制作用。在中医治疗过程中,医生应密切关注患者的生命体征和身体状况。如有不适,应立即停止治疗,并采取适当措施。

因此,中药外治法是治疗CIPN的有效方法,能显着改善CIPN患者的临床症状和生活质量。这些结果可以指导临床实践。由于研究的局限性,尚需进一步设计严谨、大规模、多中心的RCT试验,全面评价CHM外治CIPN的疗效,以提供更可靠的证据。

 

原文:Li QY, Cai FH, Lu Y, Liu H, Wang X, Li FL, Shi J. External Treatment With Chinese Herbal Medicine for Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis. Front Pharmacol. 2022 Feb 18;13:764473. doi: 10.3389/fphar.2022.764473. PMID: 35250555; PMCID: PMC8894889.

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    2022-12-28 zll0637
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    2022-11-26 venlin
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    2022-04-09 huagfeg
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具有神经保护作用的中药具有抗氧化、抗炎、抗肿瘤、抗脓毒症、镇痛的特性。最近的研究表明,活性氧(ROS) 的减少降低了 α-突触核蛋白 (α-syn) 的毒性并增强了多巴胺能神经元再生,PD的主要标志。

进展与未来机遇:中医药治疗自身免疫性肝炎

自身免疫性肝炎(AIH)是一种慢性炎症性肝病,发生在所有年龄段的个体中,女性发病率较高,其特征是高丙种球蛋白血症、血清自身抗体升高和界面性肝炎的组织学特征。AIH 的发病机制仍不清楚,仍需要深入研究。

Biomed Pharmacother:中药及天然提取物治疗狼疮性肾炎的进展

狼疮性肾炎(LN)是一种多系统受累的自身免疫性疾病,也是系统性红斑狼疮(SLE)中最严重的器官损害形式之一,主要由肾小球内免疫复合物的形成和沉积引起。超过50%的SLE患者有肾损害的临床表现。

中医药逆转癌症多药耐药及其机制

化疗是目前可用的癌症治疗方法中最常用的临床治疗方法之一。然而,多药耐药(MDR)现象已成为治疗过程中的挑战,削弱了化疗的影响。对阐明癌症 MDR 发展的广泛研究已经确定机制。

千金藤素治疗新冠肺炎临床试验获批

近日,加拿大药企Pharmadrug宣布成功举办了与美国FDA的Pre-IND会议,就千金藤素