目的:研究针灸对胃癌患者化疗后并发症和不良事件的影响。通过对现有随机对照试验(RCT)的荟萃分析,本研究旨在加强证据基础,帮助研究者进一步了解艾灸和针刺对GC患者术后并发症和化疗不良事件的影响.
方法:Embase,WebofScience,PubMed,科克伦图书馆,中国国家知识基础设施(CNKI),万方数据库,检索中国技术期刊VIP数据库,收集针灸对接受手术和化疗的GC患者胃肠功能和AE的影响的随机对照试验。结果测量包括术后胃肠道恢复(肠鸣音恢复时间,第一次排气/排便/进食的时间),AEs的发生率(恶心和呕吐,腹胀,和腹泻),骨髓抑制(白细胞,血红蛋白,和血小板),免疫功能指标(CD3+和CD4+)。为了评估质量,利用了Cochrane偏差风险工具。实施ReviewManager5.4进行荟萃分析。
结果:15个符合条件的RCTs涉及1259例患者。Meta分析结果显示实验组肠鸣音恢复时间明显缩短(MD=-14.57,95%CI=[-18.97,-10.18],P<0.00001),至首次排气的时间(MD=-17.56,95%CI=[-22.23,-12.88],P<0.00001),首次排便时间(MD=-17.05,95%CI=[-21.02,-13.09],P<0.00001),和第一次进食时间(MD=-23.49,95%CI=[-28.81,-18.17],P<0.00001)高于对照组。恶心和呕吐的发生率显着降低(RR=0.46,95%CI=[0.21,1.02],P=0.05)和腹胀(RR=0.45,95%CI=[0.27,0.75],与对照组相比,实验组观察到P=0.002)。与对照组相比,实验组的白细胞计数显着增加(MD=0.89,95%CI=[0.23,1.55],P=0.008)。实验组的CD3+水平显著升高(MD=7.30,95%CI=[1.86,12.74],P=0.009)和CD4+(MD=2.75,95%CI=[1.61,3.90],P<0.00001)高于对照组。
结论:在GC患者中,针灸可以帮助胃肠功能恢复,降低手术和化疗的AE发生率,提高免疫功能。
OBJECTIVE: The impact of acupuncture and moxibustion on postoperative complications and adverse events (AEs) of chemotherapy in patients with gastric cancer (GC) has been investigated. Through a meta-analysis of existing randomized controlled trials (RCTs), this study sought to strengthen the evidentiary basis to help investigators further understand the effects of moxibustion and acupuncture on postoperative complications and AEs of chemotherapy among GC patients.
METHODS: Embase, Web of Science, PubMed, The Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database for Chinese Technical Periodicals were searched to collect RCTs on effects of acupuncture and moxibustion on gastrointestinal function and AEs among GC patients undergoing surgery and chemotherapy. Outcome measures included postoperative gastrointestinal recovery (bowel sound recovery time, time to first flatus/defecation/feeding), the incidence of AEs (nausea and vomiting, abdominal distension, and diarrhea), myelosuppression (white blood cells, hemoglobin, and platelet), and immune function indicators (CD3+ and CD4+). To assess quality, the Cochrane Risk of Bias Tool was utilized. Review Manager 5.4 was implemented to do the meta-analysis.
RESULTS: Fifteen eligible RCTs involved 1259 patients. Meta-analysis results showed that the experimental group had a significantly shorter bowel sound recovery time (MD = - 14.57, 95% CI = [- 18.97, - 10.18], P < 0.00001), time to first flatus (MD = - 17.56, 95% CI = [- 22.23, - 12.88], P < 0.00001), time to first defecation (MD = - 17.05, 95% CI = [- 21.02, - 13.09], P < 0.00001), and time to first feeding (MD = - 23.49, 95% CI = [- 28.81, - 18.17], P < 0.00001) than the control group. There were significant decreases in the incidence of nausea and vomiting (RR = 0.46, 95% CI = [0.21, 1.02], P = 0.05) and abdominal distension (RR = 0.45, 95% CI = [0.27, 0.75], P = 0.002) observed in the experimental group in comparison with the control group. The experimental group demonstrated a significant increase in white blood cell counts in comparison with to the control group (MD = 0.89, 95% CI = [0.23, 1.55], P = 0.008). The experimental group showed significantly higher levels of CD3+ (MD = 7.30, 95% CI = [1.86, 12.74], P = 0.009) and CD4+ (MD = 2.75, 95% CI = [1.61, 3.90], P < 0.00001) than the control group.
CONCLUSIONS: Among GC patients, acupuncture and moxibustion can aid in gastrointestinal function recovery, reduce the incidence of AEs of surgery and chemotherapy, and improve immune function.