The Systematic Review And Medication Rules Of Traditional Chinese Medicine Combined With EGFR-TKIs In The Treatment Of Non-small-Cell Lung Carcinoma

Objective: Based on the clinical randomized controlled trials(RCT)in the combined treatment of the TCM with EGFR-TKIs,this thesis will make a systematic evaluation of its curative effect.Meanwhile,according to the records of the ingredients of TCM and its decoction in the combined treatment,this thesis will analyze the medication rules to provide some evidence for the combined treatment of TCM and western medicine in NSCLC.Methods: Through computer retrieval of clinical trial database from CNKI,Wanfang Date,CBM,VIP,Pubmed,Embase and Cochrane Library and manual retrieval from documents about tumor in Guangxi library or various of libraries in medical colleges of Guangxi,studys were collected which were about combined treatment of TCM with EGFR-TKIs,and published publicly before December 31,2016,or the unpublished relevant trial results by Cochrane.We will make a meta-analysis of RCT by Evman5.3 software in accordance with the eligibility and exclusion criteria strictly to systematically evaluate the curative effect of the combined treatment of the TCM with EGFR-TKIs.While analyze the medication rules,we will build up an herbal compound database in Excel2010 and make a count on one single herb frequency of usage by SPSS19.0software.In addition,we will research the related rules of the herbcompositions through the model Apriori in IBM SPSS modeler14.1 software.Results: In the strict meta-analysis,13 studys contained 769 cases have been retrieved out.Among these cases,treatment group has 390 cases with combined treatment of the TCM with EGFR-TKIs and control group has 163 cases with pure EGFR-TKIs treatment.In the interventions of the cases,the gefitinibs are used as the EGFR-TKIs targeted agents are ten,erlotinibs are one and Icotinibs are two.Besides,herbal decoctions are used in nine cases,Chinese medicine injections are in three cases and Chinese medicine granules are in one cases.There are three papers with high quality are graded three by Jadad,and other ten papers with low quality are graded one to two.meta-analysis showed that both the response rate and the DCR of the treatment group was higher than the control group(RR=1.40,95%CI =[1.16,1.69],the effect inspection Z=3.56,P=0.0004<0.05;RR=1.19,95%CI= [1.10,1.29],the effect inspection Z=4.27,P<0.0001)in the aspect of curative effect.So the combined treatment of the TCM with EGFR-TKIs is better than pure EGFR-TKIs in the treatment.In the Karnofsky,the treatment group is also better than the control group(RR=1.60,95%CI=[1.29,1.98],the effect inspection Z=4.31,P<0.0001).In addition,the incidence of adverse reactions of the treatment group such as diarrhea and rash is less than the control group.The incidence comparison results of diarrhea and rash are as follows: RR=0.64,95%CI=[0.36,0.98],the effect inspection Z=2.58,P=0.01<0.05;RR=0.77,95%CI = [0.65,0.92],the effect inspection Z=2.96,P=0.003<0.05.The medication rules in 49 prescriptions which include 164 herbs of 37 herbal decoctions,5 Chinese medicine injections and 8 Oral Chinese patent medicine have been analyzed and the herbs frequency of usage come to 470.25 herbs,which are mainly for restoring vital energy,heat-clearing and detoxification,removing phlegm and restrainingcough and removing dampness and promoting dieresis,are used in ten percent of these prescriptions alone.In these prescriptions,the top three used pure herbs are radix astragali,radix ophiopogonis and radix glycyrrhizae.The top herb pair is(radix ophiopogonis+ adenophora stricta miq).The top three herb group is(radix astragali,adenophora stricta miq and radix Ophiopogonis).The top four herb group is(radix rehmanniae,bulbus fritillariae thunbergi,radix glycyrrhizae and radix platycodonis).Conclusions:(1)The combined treatment of the TCM with EGFR-TKIs is better than pure EGFR-TKIs in the tumor treatment,improving patients' function and reducing adverse reactions.(2)The four herbs for restoring vital energy,heat-clearing and detoxification,removing phlegm and restraining cough and removing dampness and promotingdieresis are the most commonly used in the combined treatment.And radix astragali,radix ophiopogonis,rhizoma atractylodis macrocephalae and radix glycyrrhizae are often used in combination therapy with other drug compatibility.