Microcosmic Syndrome Differentiation Of Traditional Chinese Medicine Evidence-based Medicine Conception Of Method And Its Application In The Diagnosis Of Liver Fibrosis Research

Today more and more clinical medicine workers pay attention to evidence-based medicine, including Chinese medicine workers. This study provided a new thought for building special systematic review technologies for studies of TCM type of syndromes.Hepatic fibrosis is a kind of disease, and more a concept of pathologic histology. The best method of hepatic fibrosis is liver biopsy, considered "the gold standard".Recent diagnosis test trials have shown the potential advantages of serum hepatic fibrosis markers,such as hyaluronic acid(HA), procollagen typeⅢor typeⅢprocollagenN peptide (PⅢP),typeⅣcollagen (CⅣ) and laminin (LN).To get the message of hepatic fibrosis TCM type of syndromes and it's basis in modern clinical literatures. We searched National Knowledge Infrastructure and VIP database, collected the articles and read it to select the literature according with the inclusion criteria, got the data of types of syndromes and it's bases, then dealled it with descriptive statistics. Results: 176 literatures were found, and 34 articles with 54 types of syndroma were included, and maximus 6 types were stagnation of liver-QI with deficiency of the spleen, hepatic and renal yin deficiency, asdthenic splenonephro-yang, obstruction of collaterals by blood stasis, humid heat blocked in middle energizer , qi-stagnancy and blood stasis. Splenohepatomegalia, wiry pulse, and the step up of serum levels of hepatic fibrosis owned by all 6 type of syndromes. Other symptoms , tongue demonstration, pulse demonstration, and the serum levels of hepatic fibrosis were different. serum levels of hepatic fibrosis may be needed because of the multiplicity of type of syndrome in liver fibrosis.Part 1 Systematic Review technologies for TCM type of syndromesThe knowledge and researching of symptoms is one of the bottlenecks of TCM research. There are so many difficulties in objective research of TCM syndrome. The most important idea of proixmal phalangette is construction a new method system of systematic review for TCM microcosmic syndrome differentiation researches.The essence of systematic review is the use of system theory in medical domain. Systematic review is one method of gaining optimization evidence, and has promoted development of medicine domain. systematic review is not only meta analyse. Now systematic review is not only used in RCT, but also in diagnostic test, animal experiment, and so on. systematic review for TCM microcosmic syndrome differentiation researches is consistent with the main idea of EBM. Its methods and procedures are similar to SR for RCT, but still should modifying the selection criteria for considering studies for the review, the methods used to identify relevant studies, the process used for selection of studies and collecting data, how the methodological quality of the included studies is assessed and how to Analyse and present results.Our suggestion:1 Searching for and selecting studies. The methods used to identify studies should be summarized.2 Assessing methodological quality. How the methodological quality of the included studies is assessed.we can use the modifying version of QUADAS, or investigate another methodological quality tools for TCM microcosmic syndrome differentiation researches especially.3 Investigations of heterogeneity. We should consider if all studies are in accordance with the same denominator of differentiation of symptoms and signs, and do consistency checking and so on.4 Statistical analysis and data synthesis. The most important method is descriptive statistics. And meta analyse is done when the heterogeneity can be neglected.Part 2 Systematic Review for TCM type of syndromesObjective To evaluate the clinical value of serum fibrosis markers HA,PⅢP,PCⅢ, CⅣand LN in the diagnosis of liver fibrosis. Method of the review With the searching terms including liver fibrosis or liver cirrhosis, biopsy,sensitivity and specitiality,in PUBMED, EMBASE, CBM, CNKI, VIP. All diagnostic test that compared the gold standard with serum marks included in this review.According the demand of Cochrane systemic review,selection of trial for inclusion,assessment of methological quality,data extraction and data syntheses would be conducted for each included tria1.Results 4140 articles were found and 38 were internalized. Doing rank correlation analysis for odds ratio and sample size of serologic marks, the P values are 0.338, 0.274, 0.432, 0.281, 0.234;The coincidence of"yes"in QUADAS 14 items are 12.5%,29.17%,100%,45.83%,91.66%,100%,100%,25.00%,16.67%,100%,16.67%,100%,0%,0%,"no"4.17%,58.33%,0%,54.17%,4.17%,0%,0%,0%,4.17%,0%,83.33%,0%,100%,100%。Likelihood ratios (LR) ranged from -LR 0.1 to 0.5, +LR 1.2 to 5.7, diagnostic odds ratios(DOR) were 9.0 (median) with a range of 5 to 27- mostly below values of robust tests. Tests perform with either high sensitivity with low specificity or vice versa.ConclusionsPCⅢis the best marks for distinguishing with or without hepatic fibrosis and light and heavy press hepatic fibrosis, and the LN is the last one. HA is the best marks for liver cirrhosis diagnosis. Serum markers can rule-in or rule-out fibrosis in up to part of patients, but cannot differentiate stages of fibrosis reliably. Improvement of index and reference test in needed including evaluation of clinical outcomes as reference. Improved test reporting is needed to derive LR and DOR as performance indicators.Part 3 Systematic Review for TCM type of syndromesObjective To evaluate the clinical value of serum fibrosis markers HA,PⅢP,PCⅢ, CⅣand LN in the diagnosis of liver fibrosis. Method of the review With the searching terms including liver fibrosis or liver cirrhosis, biopsy,sensitivity and specitiality,in PUBMED, EMBASE, CBM, CNKI, VIP. All TCM microcosmic syndrome differentiation researches included in this review.Data syntheses would be conducted for each included tria1 using revman 5.Results There are 377 Chinese studies and no other language study is find.9 literatures were in accordance with the same denominator of differentiation of symptoms and analyse with revman 5, find: 95% confidence interval of all investigation is in right, and one another overlapping.Conclusions 1 TCM microcosmic syndrome differentiation researches of hepatic fibrosis may be homogenicity and can be combined to be analyzed. 2 The serum marks of the group of differentiation of symptoms and signs for classification of syndrome is obviously heighten compared with the control group.The researches on the system, firstly, are conducted on the systematic review technologies for TCM microcosmic syndrome differentiation researches. Estimate the diagnostic efficacy of serum marks for hepatic fibrosis. Investigate the relationship of differentiation of symptoms and signs for classification of syndrome and serum marks. weeds through the old to bring forth the new incontent and technolodgy.