Study Of Systematic Review And Meta Analysis Of Effectiveness And Safty Of Traditional Chinese Medicine In Treating Acute Ischemical Stroke

ObjectiveThe study assess and Meta analysis the effectiveness and safety of the Treatment of TCM on Acute Ischemic Stroke with the methods of evidence-based medicine from Cochrane Collaboration, to provide the evidence for the acupuncturetherapy for early patients with acute ischemical stroke (within 30d) and advice for clinical trial.MethodsReasonable and effective search strategy was made according to the demand of Cochrane Collaboration, the characteristics of each database and inclusion and excluding criteria. Then we searched randomized controlled clinical trials (RCT) from China Biology Medicine disc(CBM), China National Knowledge Infrastructure (CNKI) Database, China Science and Technology Journal Database (CSTJ), Wan-Fang Database, Chinese Clinical Trial Register (ChiCTR), MEDLINE (PubMed), Cochrane Library. Literature bolting was performed by 2 reviewers independently according to the standard of in and out, different opinions should be solved through negotiation.. All included literatures were assessed with Risk of bias table made by Cochrane Handbook 5.1.-0.Search and identify the randomized controlled trials (RCT) about TCM and western Medicine on Acute Ischemic Stroke, statistical software RevMan 5.2 was used for deta analysis. Systematic Reviews and Meta analysis for mortality, disability rate, effectiverate, NDS, ADL, MAS, adverse reaction were used to compare the efficacy and safety of TCM in Acute Ischemic Stroke. Results152 literatures (16999 patients) were included for Meta-analysis. According to different interventions, these literatures can divided into 4 subgroups.70 literatures (6016 patients) on comparison between acupuncture therapy and routine western medical therapy,67 literatures (8538 patients) on comparison between acupuncture combination therapy and non-acupuncture therapy,10 literatures (1631 patients) on comparison between combined therapy with acupuncture+rehabilitation and routine western medical therapy,4 literatures (814 patients) on comparison between acupuncture and "placebo-point" acupuncture. In this 152 literatures,64 literatures report detailed randomized method,17 literatures report allocation concealment method,3 literatures report double-blind method,17 literatures report blinded review,33 literatures report withdraw information,6 literatures report intent-to-treat analysis. Most studies are at unclear risk of bias. Quality grade of all the literatures is B.The results of Meta analysis show that routine western medical therapy Combined with acupuncture is better than routine western medical therapy. It can be shown in these aspect:mortality, disability rate, effectiverate, NDS, ADL, MAS, CRP, Chinese medical symptom score. They have similar efficacy in recurrence rate and adverse reaction at long time follow-up. Combined with acupuncture have more adverse effects than routine western medical therapy, but the adverse effects are very mild, such as mild pain, bleeding and acupuncture syncope et al. Acupuncture combination therapy is better than non-acupuncture therapy on mortality, disability rate, effectiverate, NDS, ADL, MAS, CRP, but they are not significantly different in mortality rate at follow-up period and adverse reaction. Combined therapy with acupuncture and rehabilitation is better than routine western medical therapy on effectiverate, NDS, ADL, MAS, and they are similar in adverse reaction, and no report for mortality and disability rate. As for mortality, disability rate and adverse reaction in acupuncture therapy and "placebo-point" acupuncture, it seems no significant difference between them.ConclusionMeta-analysis of efficiency and safty of TCM for Acute Ischemic Stroke suggest that routine western medical therapy combined with acupuncture can lower significantly the disability rate and improve the therapeutic effect. The safety is good. But There is no evidence acupuncture can lower the mortality, especially long-term mortality. At present, the evidence of evidence-based suggest that acupuncture should be be used for Acute Ischemic Stroke early. (within 30d). There are not significantly different between acupuncture and "placebo-point" acupuncture on efficacy and safety. The better "placebo-point" acupuncture should be researched to improve quality of randomized controlled trials and then can provide more evidence for acupuncturetherapy for acute ischemical stroke.