A Systematic Review Of Randomized Controlled Trials Of Oral Chinese Medicine Decoction Combined With Western Medicine For Intervention Of Bronchiectasis In The Acute Phase

Purpose:1.To search for the randomized controlled trial of oral traditional Chinese medicine decoction in the treatment of acute stage of bronchiectasis,and to systematically evaluate the outcome indicators,so as to provide evidence-based basis for oral traditional Chinese medicine decoction in the treatment of acute stage of bronchiectasis.2.To evaluate and analyze the methodological quality and bias risk of the randomized controlled trials,and to explore the shortcomings of the randomized controlled trials in the acute stage of bronchiectasis.Material and method:1.Search literature by computer.The retrieval database includes China National Knowledge Infrastructure(CNKI),Wan Fang database,CQVIP database,Sino Med,Pub Med and Cochrane libraries,with a limited time from the establishment of the database to December2019,selected the clinical randomized controlled trials of oral traditional Chinese medicine decoction in the acute stage of bronchiectasis that met the inclusion criteria.2.The improved Jadad scoring standard was used for quality evaluation,and Revman 5.3software was used for meta-analysis of the outcome indicators of the trials,and to carry out the literature publication bias evaluation according to the funnel chart.Results:1.The results of literature search: a total of 25 randomized controlled trials were included,including 2043 patients with bronchiectasis.All the trials were conducted in China,and there were no significant differences in gender,age and course of disease in all the medical records.Jadad scores show that 7 studies are of high quality and 18 are of low quality.2.The results of data analysis: Meta-analysis results show that,(1)In the treatment of acute stage of bronchiectasis,oral traditional Chinese medicine decoction can improve the clinical efficiency[n=2043,RR=1.19,95%CI(1.15,1.24),P<0.00001],reduce the total score of the TCM syndrome[n=575,MD=-2.30,95%CI(-2.45,-2.15),P<0.00001],relieve the symptoms of cough[n=420,MD=-0.83,95%CI(-0.93,-0.74),P<0.00001],reduce expectoration[n=187, MD=-0.39,95%CI(-0.72,-0.06),P=0.02],relievefever[n=192,MD=-0.22,95%CI(-0.90,-0.02),P=0.04],and reduce chest distress[n=183,MD=-0.55,95%CI(-0.60,-0.50),P<0.00001],shorten the time of cough[n=243,MD=-1.11,95%CI(-1.57,-0.66),P<0.00001],shorten the time of expectoration[n=163,MD=-1.03,95%CI(-1.48,-0.58),P<0.00001],and shortening fever time[n=243,MD=-1.09,95%CI(-1.46,-0.71),P<0.00001],reduce the index of procalcitonin[n=237,MD=-0.27,95%CI(-0.38,-0.16),P<0.00001],and improve the index of TIMP-1[n=301,MD=17.51,95%CI(15.04,19.98),P<0.00001],which is more effective than the traditional western medicine only,and the result is stable;(2)In the treatment of acute stage of bronchiectasis,the therapeutic effect of oral decoction of traditional Chinese medicine may be better than that of traditional western medicine alone in relieving hemoptysis symptoms[n=120,MD=-0.14,95%CI(-0.27,-0.01),P=0.03],shortening hemoptysis time[n=150,MD=-1.46,95%CI(-2.06,-0.86),P < 0.00001],reducing the index of WBC[n=624,MD=-1.13,95%CI(-1.44,-0.83),P < 0.00001],reducing the index of NEU%[n=362,MD=-3.45,95%CI(-5.14,-1.76),P <0.0001],improving the index of MMP-9[n=301,MD=10.97,95%CI(-12.40,-9.55),P<0.00001] and improve the index of PCO2[n=338,MD=-11.96,95%CI(-15.40,-8.52),P<0.00001],but the stability of the results is poor.(3)In terms of improving the C-reactive protein(CRP)index,the results of 8 different courses of study suggest that oral Traditional Chinese medicine decoction is better than western medicine in the acute stage of bronchiectasis,and the results are statistically significant(P<0.05).However,due to the strong heterogeneity of literature,meta-analysis was not carried out;(4)Adverse reactions: no serious adverse reactions were reported;(5)Publication bias: funnel chart was made for the total effective rate of 25 trials,and the image was not absolutely symmetrical,suggesting that the literature has potential publication bias.Conclusion:1.Oral Chinese herbal decoction combined with western medicine in the treatment of acute bronchiectasis,in the clinical total effective rate,relieve the main symptoms(including cough,expectoration,fever,chest tightness,hemoptysis),promote the disappearance of symptoms(including cough,expectoration,fever,hemoptysis),as well as some blood routine indicators (including WBC,NEU%),blood inflammatory indicators(including PCT,TIMP1,MMP-9),blood gas analysis In terms of index(PCO2),the curative effect is superior to that of conventional Western medicine treatment;2.The acute stage of bronchiectasis is mainly characterized by "phlegm-heat".The treatment of acute stage of bronchiectasis by "clearing away heat and resolving phlegm" combined with western medicine is effective and superior to the conventional treatment of Western medicine.3.Oral Chinese herbal decoction combined with western medicine in the treatment of acute bronchiectasis has fewer adverse reactions and good safety.