The Effect Of Traditional Chinese Medicine On Severe Acute Pancreatitis: A Systematic Review And Meta-analysis

Objectives Our goal was to evaluate the effect of traditional Chinese medicine (CTM)on Severe Acute Pancreatitis (SAP) by conducting a systematic review and meta-analysis of prospective randomized controlled study.Methods Relevant studies were identified by PubMed, Cochrane Library, EM-BASE,CBM database, CNKI database, Wanfang database, published and unpublishedliteratures should be hand searched, and reference lists of retrieved articles were alsoreviewed, up to December2013.To collect randomized controlled trials(RTCs) ontraditional Chinese medicine (TCM)for severe acute pancreatitis(SAP) at home andabroad. According to the including criteria, two reviewers independently assessedstudies for inclusion and extracted data. Jadad scale was used as quality assurance forthe papers, and the studies were analyzed by Revman5software.Either a fixed-or arandom effects model was used to evaluate the effect of TCM on SAP.Results Twenty prospective randomized controlled studies involving1676participantswere included in the meta-analysis. All studies included in the manuscript are publishedin Chinese. Jadad score results:12studies for high quality (1studies:5points,11studies:4points), the rest8studies shows that low quality (2studies:3points;6studies:2points).TCM was tested to be more effective than reference group: The relief time ofabdominalgia and abdominal distention were[SMD2.02,95%CI (1.47,2.56),P<0.00001] and[MD2.75,95%CI [2.48,3.02],P<0.00001] respectively; The recovery time ofborborygmi, Leukocytes, hemodiastase, urinary amylase were [SMD1.36,95%CI(0.70,2.02),P<0.0001],[MD3.94,95%CI (2.11,5.78)],P<0.0001],[SMD1.64,95%CI(1.10,2.18), P<0.00001],[SMD1.65,95%CI(0.83,2.47), P<0.0001] respectively;Mortality[OR2.75,95CI(1.86,4.07), P<0.00001],Operability [OR4.55,95%CI (2.54,8.16), P<0.00001],Rate of complications [OR4.00,95%CI(1.47,2.56),P<0.00001],Hospital length of stay [MD8.07,95%CI(4.97,11.18), P<0.00001] compared withreference group.Conclusions This meta-analysis provides evidence manifesting that TCM seems to bean effective and safe treatment for people with non-biliogenic Severe Acute Pancreatitis(SAP), it contribute to reduce the relief time of abdominalgia and abdominal distention.The recovery time of borborygmi, Leukocytes, hemodiastase, urinary amylase anddecrease Mortality, Operability, Hospital length of stay, Rate of complications. but theconcrete mechanism is still unclear yet. In the manuscript, methodological quality of theincluded studies is not high: all studies included were RTCs, but the allocationconcealment process was inadequate, which might have created potential selection bias;most of the studies could not report the allocation concealment process; Patientwithdrawal or not was uncertainty; formula, dose, frequency of interventions did nothave a unified treatment, which may cause that we may not be able to reach a definitiveconclusion that traditional Chinese medicine shows more effective and safe than theapproved drugs. Hence, further study of TCM in the treatment of SAP is warranted inrigorously designed, multicentre, large-scale trials with higher quality worldwide.