摘要
目的:系统评价中西医结合治疗乳腺癌术后抑郁的临床应用价值。方法:检索PubMed、维普数据库、Web of Science、中国生物医学文献数据库、万方数据库、Embase、Cochrane Library、中国知网从建库至2023年2月有关中西医结合治疗乳腺癌术后抑郁的随机对照试验研究,并通过RevMan 5.4以及Stata 14软件分析数据。结果:纳入文献11篇,患者888例。Meta分析结果表明:中西医结合治疗对比单纯西医治疗乳腺癌术后抑郁更能够降低患者中医证候积分(MD=-6.81,95%CI[-7.97,-5.66],P<0.00001),提高患者Karnofsky功能状态评分法(Karnofsky Performance Status Scale,KPS)评分改善有效率(RR=1.65,95%CI[1.16,2.35],P=0.005),提高患者免疫指标T淋巴细胞CD4^(+)(MD=7.46,95%CI[6.16,8.76],Z=11.25,P<0.00001)、CD4^(+)/CD8^(+)(MD=0.55,95%CI[0.18,0.91],Z=2.94,P=0.003),降低乳腺癌术后抑郁患者抑郁自评量表(Self Rating Depression Scale,SDS)积分(SMD=-0.85,95%CI[-1.08,-0.61],Z=7.00,P<0.0001),降低乳腺癌术后抑郁患者汉密尔顿抑郁量表(Hamilton Depression Rating Scale,HAMD)积分(MD=-7.03,95%CI[-8.37,-5.69],Z=10.28,P<0.0001),但对于免疫指标T淋巴细胞亚群中的CD8^(+)(MD=-6.69,95%CI[-16.20,2.83],Z=1.38,P=0.17),中西医结合治疗并不能提高患者免疫指标CD8~+。通过中药使用频率的分析,柴胡、芍药、茯苓、当归、甘草、白术、地黄为治疗乳腺癌患者术后相关性抑郁的常用中药。结论:中西医结合治疗乳腺癌术后抑郁能够降低患者的SDS积分、HAMD积分及中医证候积分,改善症状,提高KPS评分改善有效率及免疫指标T淋巴细胞亚群(CD4~+、CD4~+/CD8~+),但治疗前后免疫指标CD8~+的差异没有统计学意义,未来需要开展多中心、大样本、高质量的研究来探究中西医结合治疗对CD8~+的影响。
Objective:To systematic review the clinical application value of the integrative medicine in the treatment of postoperative depression in breast cancer.Methods:Through computer retrieval of VIP,CBM,Wanfang Data,CNKI,Web of Science,PubMed,Embase,and Cochrane Library,literature on randomized controlled trials(RCTs)of the integrative medicine for postoperative depression in breast cancer from the establishment of the database to February 2023 were selected.RevMan 5.4 and Stata14 software were used to analyze the data.Results:Eleven articles were included,including 888 patients.Meta-analysis results:Compared with western medicine alone,the integrative medicine could reduce TCM symptom scores of patients with breast cancer postoperative depression(MD=-6.81,95%CI[-7.97,-5.66],P<0.00001),improve the effective rate of KPS score improvement in patients(RR=1.65,95%CI[1.16,2.35],P=0.005<0.05),improve the patient’s immune indicators CD4^(+)(MD=7.46,95%CI[6.16,8.76],Z=11.25,P<0.00001),CD4^(+)/CD8^(+)(MD=0.55,95%CI[0.18,0.91],Z=2.94,P=0.003),decrease SDS score of patients with depression after breast cancer surgery(SMD=-0.85,95%CI[1.08,-0.61],Z=7.00,P<0.0001),decrease the HAMD score of patients with depression after breast cancer surgery(MD=-7.03,95%CI[-8.37,-5.69],Z=10.28,P<0.0001),but there was no statistically significant difference for the immune index T lymphocyte subsets of CD8^(+)(MD=-6.69,95%CI[-16.20,2.83],Z=1.38,P=0.17).This study shows that the combination of traditional Chinese medicine and Western medicine can not improve the immune index CD8^(+)in patients with depression after breast cancer surgery.Through the analysis of the use frequency of traditional Chinese medicine,Chaihu(Radix Bupleuri),Shaoyao(Radix Paeoniae Alba),Fuling(Poria),Danggui(Radix Angelicae Sinensis),Gancao(Radix Glycyrrhizae),Baizhu(Atractylode)and Dihuang(Radix Rehmanniae)commonly used to treat postoperative depression in patients with breast cancer.Conclusion:The integrative medicine on postoperative depression after breast cancer can reduce the patient’s SDS,HAMD and TCM symptom scores,improve the patients’symptoms,improve the patients’effective rate of KPS score improvement,and improve the patients’immune indicators T lymph subsets(CD4^(+),CD4^(+)/CD8^(+)).However,for the immune index CD8^(+),this study shows insufficient evidence,and it is necessary to carry out standardized large-sample,high-quality research to explore the impact of the integrative medicine on CD8^(+).
出处
《中医临床研究》
2024年第13期131-138,共8页
Clinical Journal Of Chinese Medicine
基金
江苏省卫健委高层次人才“六个一工程”拔尖人才项目(LGY2020003)。
关键词
中药
乳腺癌术后
抑郁
META分析
Traditional Chinese medicine
Postoperative breast cancer
Depression
Meta-analysis
