郑舒月 段桦 彭艳梅 张静怡 申文 孙晨耀 张旭 谭可欣 姜雪娇 崔慧娟

摘要 目的：評价中医药治疗表皮生长因子受体抑制剂（EGFRIs）相关皮疹的疗效及安全性。方法：在外文Web of Science、PubMed、Cochrane Library和维普数据库（VIP）、中国学术期刊全文数据库（CNKI）、万方数据库中检索从创建以来至2018年3月关于中医药治疗EGFRIs相关皮疹的随机对照试验，并手工检索补充相应文献。由研究人员对文献进行筛选和数据提取，并用Rev Man5.3进行异质性检验、敏感性分析和Meta分析。结果：纳入21项研究，共1 394例肿瘤患者，Meta分析结果显示中医药治疗EGFRIs相关皮疹的有效率、减轻皮肤瘙痒的有效率、中医症状缓解的有效率明显优于对照组（P<0.01），且中医药观察组的患者生命质量明显改善，极少出现治疗相关的不良反应。实体瘤治疗总有效率与未予中医药观察组相当（P>0.05）。结论：中医药治疗可明显缓解EGFRIs相关皮疹和瘙痒，明显缓解中医证候，提高患者的生命质量，且不影响EGFRI的抗肿瘤疗效。

关键词  表皮生长因子受体抑制剂;皮疹;中医药;Meta分析

Effects of Traditional Chinese medicine on Rash Caused by Epidermal Growth Factor Receptor Inhibitors：a Meta-Analysis

ZHENG Shuyue¹，DUAN Hua¹，PENG Yanmei³， ZHANG Jingyi¹， SHEN Wen¹， SUN Chenyao¹， ZHANG Xu¹， TAN Kexin¹， JIANG Xuejiao¹， CUI Huijuan²

（1 Beijing University of Chinese Medicine， Beijing 100029，China; 2 Department of Integrative Oncology， China-Japan Friendship Hospital， Beijing， China; 3 Fangshan Hospital， Beijing University of Chinese Medicine，Beijing 102499，China）

Abstract Objective：To evaluate the efficiency and safety of Traditional Chinese medicine （TCM） on rash caused by epidermal growth factor receptor inhibitors （EGFRIs）.Methods：The Web of Science， PubMed， Cochrane Library and VIP Database for Chinese Technical Periodicals （VIP）， China National Knowledge Infrastructure （CNKI）， Wanfang databases were searched for randomized controlled trials on the treatment of EGFRIs-related rashes from the time of creation to March 2018， and corresponding literature were manually searched to supplement.The literature and extracted data were screened by researchers， and Rev Man 5.3 was used for heterogeneity testing， sensitivity analysis， and meta-analysis.Results：Meta-analysis results showed that the effectiveness of Chinese medicine in treating EGFRIs-related rashes， the effectiveness of reducing skin itching， and the effectiveness of Chinese medicine symptom relief were significantly better than the control group （P<0.01）， and the quality of life of patients in the Chinese medicine treatment group was significantly improved.There were very few treatment-related adverse reactions.The total effective rate of solid tumor treatment is comparable to the group without traditional Chinese medicine treatment （P>0.05）.Conclusion：Traditional Chinese medicine treatment can significantly relieve EGFRIs-related rashes and itching， significantly relieve TCM syndromes， improve patients′ quality of life， and does not affect the anti-tumor efficacy of EGFRI.

Keywords Epidermal growth factor receptor inhibitors; Rash; Traditional Chinese medicine; Meta-analysis

中图分类号：R242 文献标识码：A doi：10.3969/j.issn.1673-7202.2020.08.010

近年来，分子靶向治疗成为恶性肿瘤重要的治疗手段。其中表皮生长因子受体抑制剂（Epidermal Growth Factor Receptor Inhibitors，EGFRIs）应用最为广泛。靶向药的应用使有驱动基因的肺腺癌晚期患者中位生存期从14.1个月延长至33.5个月[1]。2017年9月起，多种靶向药物纳入基本医疗保险目录，意味着更广大的人群可从中获益。EGFRIs类药物最常见的毒性是皮肤不良反应，发生率为40%～100%[2-3]。因此皮肤不良反应会日渐成为恶性肿瘤治疗的主要问题。皮肤不良反应严重影响患者生命质量，许多患者因此减少靶向药的用量甚至停药，导致病情进展[4]。靶向药相关皮疹的西医规范治疗主要是应用抗生素和激素[5]。……