Background: The prevalence of brain metastases (BM) in lung cancer patients is notably high and is associated with poor prognoses. The efficacy of standard treatment regimens in improving intracranial progression-free survival (IPFS) for lung cancer BM is markedly limited. While traditional Chinese medicine (TCM) has been effective in enhancing the quality of life and prognosis of lung cancer patients, its efficacy in treating BM remains unreported. Case presentation Here, we present a case of a middle-aged female with lung cancer BM, whose condition was assessed as progressive post-standard treatment including two local surgeries (both involving resection of cerebellar space-occupying lesions), stereotactic radiotherapy, chemotherapy and EGFR-TKIs. Subsequently, she underwent treatment with the traditional Chinese herbal formula gubenxiaoyi (GBXY). The patient was treated with GBXY for a total duration of 55 months. After treatment, a significant reduction of about 50% in intracranial lesions was observed, accompanied by an extension of both Intracranial Progression-Free Survival (IPFS) and Cognitive Deterioration-Free Survival (CDFS) exceeding 50 months. Conclusion These results demonstrate that in patients with lung cancer brain metastases (BM) unresponsive to standard treatments, GBXY not only has the potential to effectively prolong IPFS and decelerate cognitive decline, but may also contribute to a reduction in intracranial tumor burden. This suggests that GBXY could be a promising therapeutic option that warrants further investigation.

ETHNOPHARMACOLOGICAL RELEVANCE:For the treatment of hepatocellular carcinoma (HCC), compound Kushen injection (CKi) is commonly used in combination with transarterial chemoembolization (TACE).AIMS OF THE STUDY:Our objective was to evaluate the reporting quality, methodological quality, risk of bias, and certainty of evidence for CKi combined with TACE for the treatment of patients with HCC by conducting systematic reviews (SRs). The purpose of this study was to improve the clinical application of CKis, strengthen clinical decision-making regarding CKis, and inform future research.MATERIALS AND METHODS:We used eight databases to systematically search SRs of CKi combined with TACE for HCC through February 21, 2023. The quality of reporting of SRs was evaluated using the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, methodological quality using A MeaSurement Tool to Assess systematic Reviews 2, risk of bias using the Risk of Bias in Systematic Review, and certainty of evidence using the Grading of Recommendations Assessment. Finally, the assessment results were visualized by the evidence mapping method. This overview has been registered on PROSPERO with the registration title "Compound Kushen injection for hepatocellular carcinoma: An overview of systematic reviews" and registration number CRD42022369120.RESULTS:A total of 12 SRs meeting the inclusion criteria were included. In terms of reporting quality, 42% of SRs reported relatively complete reports and 58% had certain deficiencies. The methodological quality of all SRs was " critically low". The risk of bias was evaluated as low in 33% of SRs and high in 67% of SRs. The results of the evidence synthesis showed that, in the "moderate" level of evidence, CKi combined with TACE resulted in a 12.7%-21.5% benefit for one-year survival rate, 11.7%-17.2% benefit for objective response rate (ORR), 20.5%-27.1% benefit for quality of life, 22.2% benefit for nausea and vomiting, and 24.7%-27.4% benefit for leukopenia in HCC patients.CONCLUSION:In conclusion, CKi combined with TACE improved survival, ORR and quality of life in patients with HCC, and reduced adverse events. The results should be interpreted with caution due to the low methodological quality of the included SRs. The clinical efficacy of CKis must be confirmed in a large number of randomized controlled trials.

Objectives: Heparanase (HPSE), an endoglycosidase that cleaves heparan sulfate, regulates various biological processes related to tumor progression. We explore the prognostic value of HPSE and its relationship with immunotherapy response in patients with breast cancer, to improve the effectiveness of immunotherapy and increase the survival outcomes. Methods: In the study, we explored the prognostic value of HPSE through the The Cancer Genome Atlas (TCGA) database. By using the single-sample gene set enrichment analysis ( ssGSEA) method, we measured the infiltration levels of 24 immune cell types in the tumor microenvironment. Cancer Therapeutics Response Portal (CTRP) and PRISM datasets provide the area under the dose-response curve (AUC) to measure drug sensitivity. Using nomograms, we predicted overall survival ability. In vivo studies, we investigated the relationship between HPSE and immune checkpoint proteins and pro-inflammatory cytokines by immunohistochemistry of Triple-Negative Breast Cancer tumors in mice. Results: Our model demonstrated that the integrating of HPSE with the clinical stage effectively predicts patients’ survival time, highlighting high HPSE expression as a prognostic risk factor for breast cancer. Then the Receiver Operating Characteristic (ROC) curve [AUC of 1 year = 0.747, AUC of 3 years = 0.731] and Decision Curve Analysis (DCA) curve illustrated the satisfactory discriminative capacity of our model, emphasizing its valuable clinical applicability. Immune-related results showed that HPSE correlates strongly with immune infiltrating cells, immune-related genes, and the anti-cancer immunity cycle. In vivo studies have demonstrated that HPSE in breast cancer is associated with increased expression of immune checkpoint proteins CD274 and cytotoxic T lymphocyte-associated protein 4 (CTLA-4) and is positively correlated with the pro-inflammatory cytokine TNF-α. Meanwhile, we analyzed the 11 types of drugs that are sensitive to the HPSE gene. Conclusion: Our results show that HPSE can serve as an effective biomarker to predict the prognosis of breast cancer patients and reflect the impact of immunotherapy.

目的 基于数据挖掘探讨燕京肿瘤医家秦厚生治疗头颈部恶性肿瘤用药规律.方法 自首都医科大学附属北京中医医院病案室名老中医案卷中,筛选秦厚生治疗头颈部恶性肿瘤诊疗医案,采集医案的西医诊断及治疗、中医症状、组方用药信息等建立数据库,并进行描述统计分析、关联规则分析和聚类分析.结果 共纳入有效数据170条,接受手术治疗者约54.7％,放疗者约28.5％;带瘤者约78.2％;高频症状为头颈部疼痛(75)、肿物(28)、身痛(27)、憋闷(13)、乏力(11);涉及药物共154味,药物频次居前3位的是功劳叶(85)、黄岑(74)、板蓝根(74);药物类别居于前3位的是清热药(41.9％)、补虚药(12.1％)、解表药(7.1％);药性以寒为主,药味以甘居多,药物归经主入肺经.对高频药物进行关联规则分析和聚类分析.结论 对于头颈部恶性肿瘤,秦厚生教授在治疗原则上以清热解毒为主,配以养阴生津,辅以引经药助药上达于头面;在用药方面,喜用既能清热解毒,又可养阴生津的功劳叶,药组如白薇+茵陈+生牡蛎等.

目的:基于数据挖掘方法,对王笑民教授治疗非小细胞肺癌用药规律进行探究.方法:收集王笑民教授中医药治疗非小细胞肺癌病历资料并建立数据库,采用Excel、SPSS Statistics 25.0、SPSS Modeler18.0 统计软件进行频数、聚类及关联规则分析等,对用药规律进行总结.结果:本研究纳入病例168 例,男82 例,女86 例,年龄33～83 岁,症状以咳嗽、咳痰、眠差等常见,中医辨证以瘀毒、相火妄动、脾虚等多见.纳入中药处方424 首,涉及药物181 味,高频中药29 味,归经以肺、肝、脾为多,药性以寒、微寒、温为主,药味以甘、苦、辛多见.聚类分析得到5 个药组.关联规则分析得到28 条,白花蛇舌草-龙葵-白英-半枝莲-车前子,柴胡-法半夏-白芍,生黄芪-防风-炒白术常联合使用.症-证-药关联分析得出非小细胞肺癌患者以瘀毒证最为常见,常用半枝莲、白花蛇舌草、白英、龙葵、车前子.结论:王笑民教授治疗非小细胞肺癌,重在从肺、肝、脾论治,以清肺解毒、活血通滞、疏肝醒脾为治,明确邪正辨证关系及疾病发展的不同阶段,选择合适用药.

卵巢癌病达晚期,癌毒积聚日久,火热毒邪交织为病.基于"壮火食气"理论,癌毒为"壮火"之邪,能耗气伤血,使气血不调而运化失司,痰、湿、瘀应运而生.笔者结合晚期卵巢恶性肿瘤发生发展规律,从其功能、性质出发,深入基础理论探讨,从中得出启示,指导临床.本文从"壮火食气"理论内涵出发,明确了气与火的相关关系,从火与气的变化和相互作用,丰富"壮火食气"理论释义,探讨晚期卵巢恶性肿瘤论治思路.肿瘤之邪为"壮火"之邪,阳热盛烈,毒积蕴结,"壮火食气"是晚期卵巢恶性肿瘤的病机关键,肿瘤局部病邪热盛,炽热毒聚,而整体阴阳俱损、虚耗暗于内.因此,笔者基于该病机,提出了灭壮火、清火郁的局部祛邪治法,以毒攻毒,以"壮寒"灭"壮火",兼以清解火郁,使毒得以出,聚乃得解;同时,建立化痰饮、复血运的整体扶正思路,化痰行瘀,恢复气血的正常运营通调,使道路得通,二者平衡,扶正祛邪并用,把握时机,分清主次,并列举医案一则,以期为临床证治提供参考.

To the editor,Lu et al raise excellent points regarding the Hepa1-6 model of HCC. Our study1 characterized the immune microenvironment of multiple preclinical models of HCC and showed that the Hepa1-6 model in C57BL/6J mice elicits a brisk immune infiltrate that is not representative of human HCC. This may be related to a minor major histocompatibility complex haplotype difference with the C57BL/6J mouse (H2b for C57BL/6 and H2bc for Hepa1-6), resulting in an alloreactive response. We conclude that the Hepa1-6 model should not be used for testing the effects of immunotherapy-based strategies for HCC. Lu et al expand on the limitations of the Hepa 1–6 model, proposing that the variability of this model's in vivo growth should preclude its use, even for nonimmunotherapy studies. We agree with the points raised by their letter. As discussed in their letter, we observed highly variable levels of tumor growth in the subcutaneous model of Hepa1-6, including complete regressions of some tumors without any intervention. This was observed over multiple independent experiments in our group in addition to the experiments included in our manuscript. While the Hepa1-6 model is currently among the most widely used for HCC research, we agree with Lu et al that given its highly variable tumor growth, it is a poor choice for in vivo drug discovery or testing. Moreover, there is a rapidly growing appreciation that even therapies originally thought to be nonimmunotherapeutic in mechanism in fact leverage the immune system to exert the observed antitumor responses. Given the association of the immune microenvironment with sensitivity or resistance to various treatment modalities including radiotherapy, cytotoxic chemotherapy, and targeted therapies,2–5 we seek to use models that most closely resemble human disease. We hope that our work can guide the design of future studies in HCC for the benefit of the patients suffering from this disease.

目的 观察中医药改善三阴性乳腺癌术后放射治疗、化学药物治疗后患者生活质量的临床疗效.方法 2016年3月—2017年12月,根据纳入、排除标准从首都医科大学附属北京中医医院等9家北京三甲医院收入314例患者,中医组(198例)辨证论治服用中药,观察组(116例)不接受与三阴性乳腺癌相关的中医药治疗,每3～6个月对所有患者进行一次随访,直至完成3年随访.根据针对乳腺癌患者的生活质量量表、医院焦虑抑郁量表、Piper疲乏量表中文版和匹兹堡睡眠质量指数评价患者的生活质量.结果 中医组针对乳腺癌患者的生活质量量表总评分及生理状况、情感状况、功能状况及附加关注评分改善程度均大于观察组(P<0.05,P<0.01).中医组医院焦虑抑郁量表中焦虑和抑郁评分改善程度均大于观察组(P<0.01).中医组Piper疲乏量表中文版总评分及子维度行为、情绪、感觉、认知评分的改善程度均大于观察组(P<0.01).匹兹堡睡眠质量指数总评分及各子维度评分改善程度组间差异均无统计学意义.结论 中医药治疗可改善三阴性乳腺癌患者疲乏程度,缓解焦虑抑郁情绪,提高整体的生活质量,且药物安全性良好.

目的 评价超常规剂量半枝莲和白花蛇舌草治疗恶性肿瘤的安全性.方法 采用回顾性队列研究方法,连续纳人535例恶性肿瘤患者,超常规剂量半枝莲和白花蛇舌草暴露组365例,非暴露组170例,详细记录研究时间窗内所有用药及不良反应事件情况.比较暴露组和非暴露组之间不良事件OR值.将服药剂量及服药时间进行加权计算累计暴露值,比较暴露组内不同累计暴露值之间不良事件发生率.结果 由于2组之间存在混杂因素,为使组间基线资料相对均衡,进一步采用倾向评分匹配法进行2∶1匹配,匹配后暴露组和非暴露组之间不良事件差异无统计学意义(OR=1.25,95％CI 0.63～2.47,P＞0.05);暴露组内,随着累计暴露值增大,不良事件发生率呈增加趋势(x2=18.544,P＜0.001),高累计暴露值组不良事件发生率高于低累计暴露值组.结论 本研究数据暂不支持超常规剂量半枝莲/白花蛇舌草治疗恶性肿瘤可以诱发更多不良事件,但是超大剂量、长时间使用潜在诱发肝功能异常及胃肠道不适的风险趋势.

We read with interest the article of Marra et al (1), who evaluated the short-term effectiveness of the COVID-19 mRNA vaccine in immunocompromised patients. They found that a reduced immune response to the COVID-19 mRNA vaccine was present in patients with solid organ transplant and malignant diseases compared to controls. Patients with solid malignancies are often immunocompromised, so we will further explore serological response to the COVID-19 vaccine in patients with solid malignancies.

目的 评价血余蛋黄油保留灌肠治疗慢性放射性肠炎的临床疗效及安全性.方法 60例慢性放射性肠炎患者随机分为治疗组和对照组各30例.治疗组将血余蛋黄油60 ml制成灌肠液进行灌肠,对照组使用蒙脱石散3 g联合地塞米松5 mg加生理盐水配置成60 ml灌肠液进行灌肠,两组均每日1次,疗程14天,治疗结束后第14、42、70天分别随访1次.于治疗前后和随访3个时间点观察中医症状总评分(症状包括腹痛、腹泻、里急后重、黏液血便、纳食减少、乏力),治疗后比较两组患者放射反应缓解率,3次随访时比较两组放射反应反复率.治疗前后观察两组放射反应程度分布及维也纳肠镜评分(VRS)分布,并进行患者提供的主观整体营养状况评量表(PG-SGA)评分.治疗前后进行血常规、尿常规、便常规、血生化、心电图检查,并记录研究过程中不良事件发生情况.结果 对照组脱落2例,最终完成研究治疗组30例,对照组28例.治疗组治疗前后放射反应程度分级差异有统计学意义(P=0.003),对照组治疗前后差异无统计学意义(P=0.063).治疗后治疗组30例中放射反应缓解率为56.67％,对照组为17.86％,治疗组明显高于对照组(P=0.002).第3次随访时治疗组放射反应反复率为3.33％,对照组为21.4％,治疗组明显低于对照组(P=0.048).治疗前治疗组有22例、对照组有20例完成肠镜检查,治疗后治疗组和对照组各有16例完成肠镜检查,治疗组治疗前后VRS分布比较差异有统计学意义(P=0.013),对照组治疗前后差异无统计学意义(P=O.107).治疗组在降低中医症状总评分和里急后重、黏液血便症状评分方面优于对照组(P＜0.05).两组患者治疗前后PG-SGA评分比较差异均无统计学意义(P＞0.05).治疗前后两组患者无不良事件发生.结论 血余蛋黄油保留灌肠可降低慢性放射性肠炎患者放射性损伤严重程度,改善里急后重、黏液血便症状,提高放射反应缓解率,降低其复发率,且安全性好.

Radiation enteritis is a common complication of malignant tumors after radiotherapy, which seriously affects the quality of life of patients. At present, there are increasing researches on the disease, but the pathogenesis is not clear, and the treatment methods are also different. Therefore, starting from the pathological changes of radiation enteritis, this article reviews the mechanism of the acute and chronic radiation enteritis, hoping to provide clinical reference.

目的:系统评价中医药治疗慢性放射性肠炎的疗效.方法:采用计算机检索Cochrane Central、PubMed、EM-BASE、中国生物医学文献数据库(CBM)、国家知识基础设施数据库(简称中国知网,China National Knowledge Infrastructure,CNKI)、中文科技期刊数据库(简称维普资讯,Chinese Citation Database,CCD)、中国学术期刊数据库(简称万方数据库,China Sci-ence Periodical Database,CSPD),搜集中医药治疗慢性放射性肠炎的随机对照临床试验,由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man5.3软件进行Meta分析.结果:筛选出文献207篇,根据文献纳排标准,排除189篇,最终纳入18项临床研究,1427例患者,其中观察组724例,对照组703例.观察组患者临床有效率(RR=1.31,95％CI为1.25～1.39,P<0.00001)高于对照组,观察组患者肠镜下黏膜损伤缓解率(RR=1.33,95％CI为1.08～1.65,P=0.008)较对照组为高,观察组在减少炎症介质、提高免疫功能、缩短治疗时间方面均优于对照组,差异有统计学意义(P<0.05),中医药组在提高生命质量水平方面优于西医组,差异有统计学意义(P<0.05).结论:中医药可有效缓解慢性放射性肠炎患者腹痛、腹泻、便血、乏力等相关症状,且能有效促进肠黏膜的愈合.

文章从《周易》卦象入手,探索人体之于此两卦之间的联系.结合文献,对火水未济的基本概念、病因病机、临床表现、中医辨治进行整理与探究分析,最终从不同病证出发,阐释火水未济病机与疾病发生发展之间的关系,从中得到临证启示,以期为今后中医理论的传承与发展奠定基础.

Background: Nanoparticle albumin-bound paclitaxel (nab-PTX) has exhibited clinical efficacy in breast cancer treatment, but toxicities can be yielded more at the same time. We did this meta-analysis aiming to unambiguously compare nab-PTX with conventional solvent-based paclitaxel (sb-PTX) in breast cancer patients of all stages. Method: Pubmed, Embase and Cochrane Library were searched for head-to-head randomized controlled trials of nab-PTX and sb-PTX in breast cancer. Risk ratio (RR) with 95% confidence interval was used for dichotomous variables while Hazard ratio (HR) was used for time-to-event outcomes. Results: Our review finally included 9 studies with 3508 patients. Nab-PTX showed a benefit on objective response rate (ORR) (RR=1.22 [1.04-1.43], P=0.01) as well as non-inferiority compared with sb-PTX in disease control rate (DCR) (RR=1.01 [0.98-1.04], P=0.44), overall survival (OS) (HR=0.99 [0.93-1.05], P=0.81) and disease free survival/progression free survival (DFS/PFS) (HR=0.92 [0.81-1.05], P=0.21). However, when it comes to toxicities (fatigue, nausea or vomiting, peripheral sensory neuropathy and adverse event related discontinuation), results favored sb-PTX (RR=2.89 [1.07-7.8], 3.15 [1.78-5.59], 2.11 [1.32-3.37], 2.02 [1.61-2.53]; P<0.05). Patients with metastatic tumors or undergoing conventional schedule responses better to nab-PTX than the compared groups (RR of ORR in metastatic vs early or locally advanced patients: 1.46 [1.09-1.96] vs 1.01 [0.94-1.08]; conventional vs dose dense group: 1.59 [1.23-2.06] vs 1.01 [0.91-1.12]). Conclusions: Nab-PTX can improve ORR compared with paclitaxel and should be given priority to when aiming to reduce tumor load in breast cancer. Sb-PTX of dose dense schedule is recommended when toxicity of nab-PTX is hard to bear for breast cancer patients.

Abstract Background: Nanoparticle albumin-bound paclitaxel (nab-PTX) has exhibited clinical efficacy in breast cancer treatment, but toxicities can be yielded more at the same time. We did this meta-analysis aiming to unambiguously compare nab-PTX with conventional solvent-based paclitaxel in breast cancer patients of all stages. Method: Pubmed, EMBASE, Cochrane Library, Chinese Biomedical database, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodical database, and WangFang database were searched for head-to-head randomized controlled trials of nab-PTX and solvent-based paclitaxel in breast cancer. Other sources will also be searched like Google Scholar and gray literatures. Two researchers will independently search the database and extract data from the articles. Risk of bias will be assessed using the Cochrane Collaboration's tool. Objective tumor response rate, chemotherapy completion rate after 4 or 6 cycles, and toxicity will be primary outcomes. Disease control rate, overall survival, and progression-free survival/disease-free survival will be included in secondary outcomes. Risk ratio with 95% confidence interval was used for dichotomous variables while hazard ratio was used for time-to-event outcomes. The following 3 data sets will all be considered when synthesizing the data: intention-to-treat population, those who actually received taxanes treatment, and those who were actually assessed. All the analyses were done using Review Manager Software 5.3. Any disagreements in study selection, data collection, and analysis will be resolved by a third investigator. Results and conclusion: This study is aim to evaluate the efficacy and safety of nab-PTX compared with PTX in breast cancer treatment as well as to find the best dose or schedule and identify the benefit population. This meta-analysis could provide evidence for clinicians to make a better choice between nab-PTX and PTX in different specific contexts. Prospero registration number: CRD42019117912.

Objective: We explored the clinical regularity and prognosis of lung carcinoma (LC) patients with hypercoagulability, which is often associated with the occurrence and development of tumors.Methods: This retrospective study analyzed 624 LC patients diagnosed from 2010-2017 in the Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, China.Kaplan-Meier analysis was used to estimate survival and the log-rank test was used to identify differences in survival between groups.The predictive power of a hypercoagulation model was tested using receiver operating characteristic (ROC) curve analysis.Univariate and multivariate Cox regression analyses were performed to explore independent factors associated with survival.A logistic regression model was used to explore factors related to hypercoagulability.The diagnostic power of relevant influencing factors on hypercoagulability was tested using ROC curve analysis.Results: Of 624 patients in the study, 161(25.8%)had hypercoagulability and 463 did not (normal group).The overall survival (OS) of the hypercoagulability group was significantly lower than the normal group (P < 0.0001).The ROC curve showed that the predictive power of the hypercoagulability model was better than that of a single coagulation indicator (P < 0.01).Both univariate and multivariate Cox regression analyses showed that hypercoagulability was an independent factor affecting the prognosis of LC (P<0.0001).The results of the logistic regression analysis showed that clinical stage (P < 0.05), cytokeratin 19 fragment (Cyfra211) (P < 0.05), and the platelet-to-lymphocyte ratio (PLR) (P < 0.05) were positively correlated with hypercoagulability.When combining clinical stage, Cyfra211, and the PLR to predict hypercoagulability, the area under the ROC curve was 0.797 (P < 0.01).Conclusions: In LC, hypercoagulability is an independent factor associated with poor OS and could be a prognostic factor.

A potential relationship between poor prognosis and thrombocytosis has been suggested by previous studies in lung cancer, but the conclusions continued to be controversial. Here, we performed a meta-analysis to explore the prognostic impact of thrombocytosis in lung cancer. The Cochrane Library, EMBASE and PubMed databases were comprehensively and systematically retrieved from establishment to May 5, 2020. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were applied to evaluate overall effects. Heterogeneity was assessed using I(2)statistics and Cochran's Q test. Sensitivity and subgroup analyses were performed to analyze the sources of heterogeneity. Publication bias was examined using the Egger's test and pooled HR was regulated using the trim-and-fill approach when publication bias was observed. A total of 37 studies including 14,833 patients were enrolled in the meta-analysis. Thrombocytosis was significantly correlated to poor overall survival (HR 1.033; 95% CI 1.017-1.050), disease-free survival (HR 1.568; 95% CI 1.276-1.928), and progression-free survival (HR 1.653; 95% CI 1.069-2.556). Although publication bias was identified, rectification for this bias using the trim-and-fill approach did not change the combined HR substantially. In conclusion, this meta-analysis result suggested that thrombocytosis is a predictor of poor prognosis in lung cancer.

目的 利用Meta分析法评价中医外治法治疗急性放射性皮炎的临床疗效.方法 采用计算机检索Cochrane Central、PubMed、EM-BASE、Web of Science、Science Direct、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普中文科技期刊全文数据库(VIP)、万方数据知识服务平台(WANFANG DATA)、读秀学术搜索数据库、百链学术搜索数据库,筛选出中医外治法治疗急性放射性皮炎的随机对照临床试验,由2名研究者独立筛选文献、提取资料并对纳入研究进行偏倚风险评估后,用Rev Man 5.3软件进行Meta分析.结果 筛选出文献280篇,根据文献纳排标准,共排除263篇,最终纳入17项临床研究,共计1 453例患者,其中试验组736例,对照组717例.与西药组比较,中医外治法能显著提高急性放射性皮炎的临床有效率[RR=1.27,95％CI(1.17,1.39),P＜0.01].预防性用药能显著改善患者症状,中医药外治较西药组预防重度放射性皮肤损伤的发生效果更优[RR=0.25,95％CI(0.16,0.38),P＜0.01],但对于预防轻度放射性皮肤损伤的发生中医药外治可能劣于西药组[RR=1.17,95％CI(1.03,1.33),P=0.02].对于急性放射性皮炎反应评分,中医外治及西药组在一定程度上均能降低其评分,差异无统计学意义[MD=-1.67,95％CI(-4.41,0.79),P=0.18].中医药外治能有效缩短临床治愈时间[MD=-4.28,95％CI(-6.18,-2.38),P＜0.01],能在一定程度上提高患者生活质量[MD=3.17,95％CI(0.15,7.27),P=0.04],但仍需更多研究证实.另外根据文献报道,中医药外治在改善皮肤损伤所致疼痛方面有一定优势(P＜0.05),但仍需更多数据支持.结论 基于目前的研究,中医药外治法对于急性放射性皮炎具有一定的治疗效果,无论在皮损状态亦或是患者相关症状改善等方面,均表现出了一定的积极作用,但是由于纳入研究质量不高,数量较少,因此需要更多高质量、大样本、多中心的随机对照研究进一步验证其疗效,从而为临床提供更高质量的循证医学证据.

放疗作为腹盆腔恶性肿瘤综合治疗的重要手段之一,对提高局部肿瘤控制率、降低复发转移率意义重大.虽然近些年来放疗精准度在不断提高,但随着腹盆腔恶性肿瘤发病率的提高、放疗技术的普及,放射性肠炎的患病人数也呈现较大基数.放射性肠炎(radiation enteritis,RE)是盆腔、腹腔及腹膜后肿瘤放疗后常见的一种放射性损伤[1],一般临床上根据肠道所受辐射剂量、时间及病势缓急,将其分为急性和慢性两种,临床上多表现为腹痛、腹泻、便次增多、黏液脓血便甚至鲜血便[2].