刘晓彤 刘晓婷 刘金响 杨娜 叶峥嵘

摘要 目的：评价阳和汤治疗肿瘤的临床疗效与安全性。方法：全面检索2018年10月以前CNKI、维普、万方、pubmed、中国生物医学文献数据库等数据库，筛选随机对照试验（Randomized Controlled Tests，RCTs），采用RevMan 5.3软件对纳入的研究资料进行Meta分析，用Jadad量表评价文献质量。结果：共纳入6篇临床资料，Meta分析结果示：总有效率：RR=1.46，95% CI=[1.22，1.74]，Z=4.23，P<0.05，I2=0%，表明阳和汤或阳和汤联合放化疗治疗肿瘤效果优于单纯使用放化疗手段;阳和汤治疗肿瘤过程中，不良反应多为放化疗引起的患者不适，包括恶心呕吐、食欲减退等。结论：阳和汤观察组可显著提高患者生存、生命质量，减轻患者痛苦。但本系统评价存在一定的发表偏倚。考虑纳入文献质量较低，实验设计存在缺陷仍需大量严谨的临床随机对照试验进行验证。

关键词 阳和汤;肿瘤;系统评价;Meta分析;循证医学;中医药;癌症;辅助治疗

Systematic Review and Meta-analysis of Yanghe Decoction in Treating Tumor

Liu Xiaotong，Liu Xiaoting，Liu Jinxiang，Yang Na，Ye Zhengrong

（Shaanxi University of Chinese Medicine，Xianyang 712046，China）

Abstract Objective：To evaluate the clinical efficacy and safety of Yanghe Decoction in treating tumor.Methods：All the papers published before October 2018 from databases such as Chinese National Knowledge Infrastructure（CNKI），Vip，Wanfang database，PubMed and China Biology Medicine（CBM）were retrieved，and randomized controlled trials（RCTs）were screened.Meta-analysis on the selected study materials was conducted with RevMan 5.3 software，and Jadad scale was used to evaluate the quality of these papers.Results：A total of 6 clinical materials were included.The meta-analysis showed：total effective rate：RR=1.46，95% CI=[1.22，1.74]，Z=4.39，P<0.05，I2=0%，which revealed that the efficacy of Yanghe Decoction or Yanghe Decoction combined with chemoradiotherapy in treating tumor were superior to using chemoradiotherapy alone.The adverse reaction in the process of using Yanghe Decoction to treat tumor was mostly discomfort caused chemoradiotherapy，including nausea，vomiting，anorexia，and so on.Conclusion：The Yanghe Decoction treatment group can remarkably improve patients′ survival quality and life quality and relieve patients′ pain.But this systematic review had some kind of publication bias.The quality of the included papers is relatively low.The experimental design had defects and a large amount of serious clinical RCTs are still needed to verify the results.

Key Words Yanghe Decoction; Tumor; Systematic review; Meta-analysis; Evident-based medicine; Traditional Chinese medicine; Cancer; Adjuvant treatment

中图分类号：R73;R256文献标识码：Adoi：10.3969/j.issn.1673-7202.2019.12.026

进入21世纪以来，中国肿瘤患病人数逐年升高，并呈現年轻化趋势，已严重威胁国人健康。在“全国第三次死因调查回顾抽样分析”结果显示[1]，肿瘤死亡率由73.99/10万上升至135.88/10万。癌症是城市居民的第一大死因，农村居民的第2大死因[1]。而在2013年的调查中，肺癌致死位列第一，之后是胃癌。发病前5名分别是肺癌、胃癌、肝癌、结直肠癌和乳腺癌，死因前五名分别是肺癌、肝癌、胃癌、食管癌和结直肠癌，全球主要癌症发病第一的是乳腺癌，死因第一的是肺癌[1]，肿瘤的治疗迫在眉睫。

现代医学治疗癌症的疗效不容置疑，但患者往往需要面对高昂的治疗成本，极其痛苦的治疗过程并伴随生命质量，生命质量的严重下降。更严重者，由于放化疗的严重不良反应而加速了患者死亡。

中医学对肿瘤的治疗也已延续数千年，阳和汤作为温阳法的代表方剂，同时具有抗癌抑癌和放化疗药物增敏作用[2]。在临床中阳和汤也广泛应用于肺癌、乳腺癌等癌症的治疗中。近年来大量临床研究[3-8]表明，阳和汤对肿瘤的治疗有较好的疗效，对改善患者生命质量，延续患者生命起到很好的作用。……