| Objective:The efficacy and safety of the method of qi-benefiting and bloodactivating in the treatment of cervical spondylosis of vertebral artery type were systematically evaluated,and further verified the effectiveness and safety of qi-benefiting and blood-activating in the treatment of cervical spondylosis of vertebral artery type were further verified through clinical studies.Methods:1.Meta-analysis: With " cervical spondylosis of vertebral artery type,Qi-benefiting,blood-activating,etc." as the keywords,the search period was set to build a library-on December 31,2021,the system searched the Chinese Academic Journals Full-text Database(CNKI),Wan Fang Data Knowledge Service Platform(Wan Fang),Weipu Full-text Journals Database(VIP),Pubmed,Cochrane Library,Web of Science.Articles were screened and data were extracted according to inclusion-exclusion criteria.The quality of the included literature was then assessed by referring to the Cochrane Systematic Assessor’s Handbook.Finally,Meta-analysis was performed on the included studies using Review Manager 5.4 software,and subgroup analysis and sensitivity analysis were performed on the results when necessary,and each outcome indicator was presented as a forest plot,and the publication bias of the literature was presented as a funnel plot.2.Clinical study: According to the inclusion and exclusion criteria,60 patients with vertebral artery cervical spondylosis who meet the requirements were divided into an experimental group(30 cases)and a control group(30 cases)by random number table method.Based on cervical spine function exercise,the experimental group was given Gegen Erteng Decoction;The control group was given Da Huo Luo Jiao Nang.After 2consecutive courses of treatment,the improvement of the evaluation scale for cervical vertigo(ESCV)of cervical vertigo before and after treatment was observed,to evaluate the clinical efficacy of Gegen Erteng Decoction.Results:1.Meta-analysis: A total of 80 articles were included,with a total sample size of 7765 cases,4059 cases in the experimental group,and 3706 cases in the control group.Meta-analysis yielded the following results:(1)effective rate: Efficiency was analysed in 72 articles,and the results were: [OR=3.71;95% CI(3.17,4.33);Z=16.43;P<0.00001].(2)Hemodynamics:Eighteen studies reported the mean blood flow velocity of the left vertebral artery,and the results were: [MD=4.32;95% CI(3.25,5.39);Z=7.92;P<0.00001];Thirteen studies reported peak systolic velocity in the left vertebral artery as follows results: [MD=4.56;95% CI(2.33,6.79);Z=4.02;P<0.0001];Seven studies reported peak diastolic velocity in the left vertebral artery with the following results: [MD=4.28;95% CI(2.86,5.71);Z=5.90;P<0.0001];Eighteen studies reported mean blood flow velocity in the right vertebral artery with results: [MD = 4.38;95% CI(3.16,5.61);Z=7.04;P<0.00001];The hemodynamic results of seven studies involving peak diastolic velocity of the right vertebral artery were:[MD=4.67;95% CI(2.90,6.44);Z=5.17;P<0.00001];The hemodynamic results of 13 studies involving peak systolic velocity of the right vertebral artery were: [MD = 4.58;95% CI(2.83,6.82);Z=5.13;P<0.00001];Twentythree studies had hemodynamic results involving mean basilar artery velocity and the results were: [MD = 3.84;95% CI(2.58,5.09);Z=5.99;P<0.00001];There are 13 studies in which hemodynamic results relate to peak systolic velocity of the basilar artery.The results were: [MD=5.73;95% CI(2.66,8.81);Z=3.66;P =0.0003];Seven studies of hemodynamic results involving peak basilar artery diastolic velocities were: [MD=3.13;95% CI(1.74,4.51);Z=4.41;P<0.0001].(3)Hemorheology: Seven literature reported on indexes about whole blood high shear rate,and the results were: [MD=-0.62;95% CI(-0.99,-0.25);Z=3.30;P =0.001];Seven studies reported on indexes about whole blood low shear rate,and the results were:[MD=-1.07;95% CI(-1.46,-0.69);Z=5.47;P<0.00001];Plasma viscosity indexes were reported in seven studies and the results were: [MD=-0.22;95% CI(-0.27,-0.17);Z=8.26;P<0.00001];Hematocrit indexes were reported in six studies with results as [MD=-1.56;95% CI(-2.20,-0.92);Z=4.78;P<0.00001];Five studies reported erythrocyte aggregation index with results of [MD=-0.43;95% CI(-0.65,-0.22);Z=3.97;P<0.0001].(4)Evaluation scale for cervical vertigo(ESCV): six articles reported on vertigo entries in ESCV,and the results were: [MD=2.65;95% CI(2.13,3.16);Z=10.10;P<0.00001];Five articles reported on headache,neck and shoulder pain,daily life and work,and psychosocial adaptation in ESCV,with the results [MD=0.41;95% CI(0.22,0.59);Z=4.27;P<0.0001],[MD=0.42;95% CI(-0.02,0.86);Z=1.88;P =0.06],[MD=0.84;95% CI(0.61,1.06);Z=7.24;P<0.00001],[MD=0.54;95% CI(0.27,0.81);Z=3.90;P<0.0001].(5)Vasoactive substances: four studies reported endothelin,and the results were: [MD=-17.12;95% CI(-36.01,1.77);Z=1.78;P =0.08];Nitric oxide was reported in three studies and the results were: [MD =3.98;95% CI(-4.50,12.47);Z=0.92;P =0.36].(6)Adverse reactions:Adverse reactions were mentioned in 11 kinds of literature,of which only3 were adverse reactions in patients in the experimental group.2.Clinical research: The results of the intra-group comparison showed that compared with before treatment,the total score of the evaluation scale for cervical vertigo(ESCV)after treatment in the experimental group and the control group was significantly increased,which was statistically significant(P<0.05);the results of the comparison between groups showed that compared with the control group,the total score of Evaluation scale for cervical vertigo(ESCV)in the experimental group was significantly improved,and the difference was statistically significant(P<0.05);the total effective rate of the experimental group was 96.67% The overall effective rate was 80% better than that of the control group,and the difference was statistically significant(P<0.05);no adverse reactions occurred in either group.Conclusion:1.By Meta-analysis,it was found that qi-benefiting and bloodactivating method was more effective and safer than other therapies in the treatment of cervical spondylosis of vertebral artery type.2.Qi-benefiting and blood-activating method has advantages over other therapies in improving hemodynamic indexes of vertebral artery and basilar artery in vertebral artery type cervical spondylosis;blood rheological indexes such as high cut whole blood viscosity,low cut whole blood viscosity,plasma viscosity,erythrocyte specific volume,and erythrocyte aggregation index;clinical symptoms such as headache and dizziness;and improving daily life and work,psychological and social adaptation.3.The effectiveness and safety of the qi-benefiting and bloodactivating method in the treatment of cervical spondylosis of vertebral artery type was confirmed in the clinical study using the formula of Gegen Erteng Decoction.4.The Gegen Erteng Decoction can effectively improve the clinical symptoms and the quality of life of patients with cervical spondylosis of vertebral artery type. |
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