Meta Analysis Of Traditional Chinese Medicine In The Treatment Of Multiple Sclerosis

ObjectiveThe systematic evaluation method of the Cochrane collaboration was used to evaluate the quality,qualitative analysis,quantitative analysis,publication bias analysis and efficacy evaluation of the domestic and foreign literature on randomized controlled trials using traditional Chinese medicine in the treatment of multiple sclerosis,so as to provide evidence-based medical evidence for the clinical application of traditional Chinese medicine in the treatment of multiple sclerosis.MethodsAccording to the search terms,appropriate search strategies were formulated,and Chinese and English databases were systematically searched:Embase,Pubmed,The Cochrane Library,Chinese Biomedical database,wanfang database,China National Knowledge Infrastructure database,and Chinese Science and Technology Periodical database.Chinese and English literatures on the treatment of multiple sclerosis with traditional Chinese medicine were retrieved.The retrieval period was from each database established time to January 1st,2019.Strict inclusion and exclusion criteria were established.All the retrieved literatures were imported into NoteExpress software for repeated literatures screening.After the duplicated literatures were deleted,the two researchers carefully read the abstract of the literature title and the full text for literature screening according to the established inclusion and exclusion criteria.Data were extracted from the last included literatures,and the literatures were evaluated for quality using the risk bias assessment tool provided by the Cochrane collaboration,and a graph was drawn.Effective data extracted from the literature including Kurtzke Extended Disability Status Scale,recurrence frequency,total effective rate,neurological signs score and clinical symptoms score were imported into RevMan5.3 software for heterogeneity test and combined statistics.Heterogeneity test results were expressed by I2.If I2≤50%,fixed effect model was used to draw forest map for analysis;if I2>50%,random effect model was used to draw forest map for analysis.Funnel plot was drawn for publication bias analysis of data in the included literature with more than 10 references.To systematically evaluate the efficacy of traditional Chinese medicine in the treatment of MS.ResultsA total of 1896 articles were retrieved from Chinese and English database s,and 20 Chinese articles were selected according to inclusion and exclusion c riteria.All the 20 references were randomized controlled trials,with a total of 1438 patients with MS,801 in the treatment group and 637 in the control gro up,with a minimum sample size of 22 and a maximum sample size of 271.Among the 20 included literatures,16 literatures used Extended Disability Statu s Scale as outcome index,and the results of the heterogeneity test were:Chi2=29.00,df=15(P=0.02),I2=48%,with less heterogeneity.Meta-analysis was cond ucted by using the fixed effects model,and the results showed that MD=-0.93,95%CI=[-1.11,-0.75],P<0.00001,indicating that the Extended Disability Statu s Scale of the treatment group was lower than that of the control group.8 arti cles with recurrence frequency for outcome indicators,one cannot provide effec tive data,so the other 7 articles were extracted data and the results of the het erogeneity test were:Tau2=0.01,Chi2=12.52,df=6(P=0.05),I2=52%,with bigger h eterogeneity,meta-analysis was conducted by using the random effects model a nd the results showed that MD=-0.51,95%CI=[-0.63,-0.4],P<0.00001,the resul t was statistically significant.Thus,conducting sensitivity analysis and eliminatin g the study of which interventions were not the same as the rest of the studie s,heterogeneity test was performed and the results were:Chi2=7.99,df=5(P=0.16),I2=37%,with less heterogeneity,meta-analysis was conducted by using the fixed effects model,and the results showed that MD=-0.55,95%CI=[-0.62,-0.47],P<0.00001.And the results were similar,indicating that the sensitivity was not big and the recurrence rate in treatment group was lower than that in the control group.In 15 articles,the total effective rate was used as the outcome index,and the results of the heterogeneity test were as follows:Chi2=5.14,df=14(P=0.98),I2=0%,with no significant heterogeneity.Meta-analysis was conducted by using fixed effects model,and the results showed that OR=4.85,95%CI=[3.48,6.76],P<0.00001,indicating that the total effective rate in the treatment group was hig her than that in the control group.8 articles with neurologic symptoms score f or outcome indicators,one for single neurologic symptoms score cannot merge statistics,so the other 7 articles were extracted data and the results of the hete rogeneity test were:Chi2=7.19,df=6(P=0.30),12=17%,with less heterogeneity,m eta-analysis was conducted by using the fixed effects model,and the results sho wed that SMD=-0.66,95%CI=[-0.85,-0.46],P<0.00001,the result was statistical ly significant,suggesting that neurologic symptoms score in treatment group wa s lower than that in the control group.In 11 articles,the clinical symptom scor es was used as the outcome index,and the results of the heterogeneity test we re as follows:Chi2=13.19,df=10(P=0.21),I2=24%,with less heterogeneity.Met a-analysis was conducted by using fixed effects model,and the results showed t hat MD=-3.02,95%CI=[-3.5,-2.53],P<0.00001,the result was statistically signif icant,suggesting that clinical symptom score in treatment group was lower tha n that in the control group.ConclusionThe clinical efficacy of traditional Chinese medicine in the treatment of MS is definite,which can reduce the recurrence frequency and improve the clinical symptoms and neurological signs of patients.Current meta-analysis of the included literature shows that traditional Chinese medicine treatment of MS has good advantages over western medicine treatment in terms of total effective rate,Extended Disability Status Scale,recurrence frequency,clinical symptom score and neurological signs score.However,due to the general lack of large-sized samples and irregular random methods in the included randomized controlled trials,the literature quality is not high,the level of evidence is low,and there is a certain publication bias,which may have some impacts on the results of this study,and more high-quality,large-sized samples and multi-center RCT tests are needed.