Traditional Chinese Medicine for the Prevention and Treatment of Bone Marrow Suppression after Chemotherapy Based on AMSTAR 2 and GRADE：an Overview of Systematic Reviews and Meta-Analyses

doi:10.12114/j.issn.1007-9572.2020.00.568

Abstract

Abstract: Background　Bone marrow suppression is one of the common dose-limiting toxic and side effects of chemotherapy.There have been many systematic reviews and Meta-analyses about traditional Chinese medicine（TCM）for preventing and treating bone marrow suppression after chemotherapy，but their quality is uneven，with a lack of systematic evaluation.Objective　To evaluate the methodological quality and outcome indicators quality of systematic reviews and Meta-analyses about TCM in preventing and treating post-chemotherapy bone marrow suppression by AMSTAR 2 and GRADE.Methods　The databases such as the Cochrane Library，PubMed，Web of Science，OVID，EBSCO，CBM，CNKI，Wanfang Data and VIP were searched for systematic reviews and Meta-analyses on the topic of TCM in preventing and treating bone marrow suppression after chemotherapy from inception to February，2020.AMSTAR 2 was used to assess the methodological quality，and the evidence quality of the outcome indicators was graded according to the GRADE system.Results　A total of 23 systematic reviews and Meta-analyses were enrolled，AMSTAR 2 evaluation results showed that，1 had moderate reliability，2 had low reliability，and the other 20 had extremely low reliability.The GRADE evaluation results showed that，among the totaled 62 outcome indicators from meta-analyses，2 were high-quality，11 were intermediate-quality，13 were low-quality and 36 were critically low-quality，with the main degradation factors of limitation，followed by inconsistency，imprecision and publication bias.Conclusion　Methodological quality and quality of evidence of outcome indicators of available systematic reviews and Meta-analyses about TCM in preventing and treating post-chemotherapy bone marrow suppression are both low，with general reliability of relevant conclusions，thus it is uncertain that TCM can effectively prevent and treat bone marrow suppression after chemotherapy.And more high-quality systematic reviews and Meta-analyses with rigorous design are needed in the future.

Key words: Bone marrow diseases, Chemotherapy, Med pharmacol literature TCM, Myelosuppression, Overview of systematic reviews, AMSTAR 2, GRADE

摘要： 背景　骨髓抑制是常见的化疗相关剂量限制性毒副作用之一，目前国内外已有多项关于中医药防治化疗后骨髓抑制疗效的系统评价/Meta分析，但研究质量参差不齐，尚缺乏系统性评估。目的　通过方法学质量评价工具AMSTAR 2和GRADE分级对中医药防治化疗后骨髓抑制疗效的系统评价/Meta分析进行再评价。方法　采用计算机检索the Cochrane Library、PubMed、Web of Science、OVID、EBSCO等数据库及中国生物医学文献数据库（CBM）、中国知网（CNKI）、万方数据知识服务平台（Wanfang Data）、维普网（VIP），筛选关于中医药防治化疗后骨髓抑制疗效的系统评价/Meta分析，检索时限均为建库至2020年2月。采用AMSTAR 2评价所纳入文献的方法学质量，并依据GRADE分级对所纳入文献的结局指标进行证据质量分级。结果　共纳入23篇文献，AMSTAR 2质量评价结果显示1篇文献可信度中，2篇文献可信度低，其余20篇文献可信度极低。23篇文献中应用Meta分析的结局指标共涉及62个，其中2个GRADE分级为高级，11个GRADE分级为中级，13个GRADE分级为低级，36个GRADE分级为极低级，主要降级因素为研究局限性，其次为不一致性、不精确性和发表偏倚。结论　基于AMSTAR 2质量评价和GRADE分级，现有中医药防治化疗后骨髓抑制疗效的系统评价/Meta分析的方法学质量及结局指标证据质量较低，结论可靠程度一般，无法证实中医药能有效防治化疗后骨髓抑制，未来需开展更多设计严谨的高质量系统评价/Meta分析。

关键词: 骨髓疾病, 化学疗法, 中医药学文献, 骨髓抑制, 系统评价再评价, AMSTAR 2, GRADE

XUE Mengting,YANG Min,PAN Yalan, et al. Traditional Chinese Medicine for the Prevention and Treatment of Bone Marrow Suppression after Chemotherapy Based on AMSTAR 2 and GRADE：an Overview of Systematic Reviews and Meta-Analyses　[J]. Chinese General Practice, 2021, 24(6): 718-726. DOI: 10.12114/j.issn.1007-9572.2020.00.568.
薛梦婷,杨敏,潘娅岚等. 基于AMSTAR 2质量评价和GRADE分级的中医药防治化疗后骨髓抑制疗效系统评价/Meta分析的再评价[J]. 中国全科医学, 2021, 24(6): 718-726. DOI: 10.12114/j.issn.1007-9572.2020.00.568.

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