| This article is composed of two parts.The part one is a meta-analysis of non-alcoholic fatty liver disease(NAFLD)with Traditional Chinese Medicine(TCM)characterized chronic disease management The part two is the cl inical study of NAFLD with TCM characterized chronic disease management.Part 1ObjectivesTo systematically evaluate the randomized controlled trials(RCTs)of TCM char acterized chronic di sease management for NAFLD patients,and then provide evidence for the clinical application of TCM characterized chronic disease management.MethodsFour databases,China Knowledge Resource Integrated Database(CNKI),Wanfang Data Knowledge Service Platform,China Biomedical Literature Database(CBM),and VIP Chinese Journal Service Platform(VIP)were searched by computer.The search deadl ine was set to December 31,2019.The RCTs of TCM characterized chronic disease management for NAFLD patients were collected,and the data of outcome indicators including the body mass index(BMI),triglyceride(TG),total cholesterol(TC),and low density lipoprotein(LDL),high density lipoprotein(HDL),alanine transaminase(ALT),aspartate transaminase(AST)were extracted to perform the meta-analysis using RevMan5.3 software.ResultA total of 7 studies were included,with a total of 669 patients,including 341 in the treatment group and 328 in the control group.Meta analysis showed that the treatment of NAFLD in the treatment group was botter than the control group in improving BMI and TG.However,the results of the meta analysis of LDL and HDL showed no significant difference between the treatment group and the control group.The heterogeneities of TC and ALT were too large.After removing the articles which heterogeneities were large through sensitivity analysis,the results of the meta analysis showed that the treatment group was better than the control group.The heterogeneity of AST was too large.Subgroup analysis was performed of whether the intervention in the treatment group was based on traditional Chinese medicine prescriptions.It was found that the treatment group treated with a variety of traditional Chinese medici ne treatments was not significantly different from the control gr oup in improving AST,while the treatment group mainly treated with traditional Chinese medicine prescriptions was better than the control group in improving AST.ConclusionTCM characterized chronic disease management has certain advantages for NAFLD patients in improving BMI,blood lipids,liver function and so on.Part 2ObjectivesTo explore the clinical effects of TCM characterized chronic disease management for NAFLD patients.MethodsA randomized contr olled study was performed in NAFLD patients who were treated in the inpatient department and outpatient department of Hepatic Department of Guangdong Provincial Hospital of Chinese Medicine from October 2018 to June 2019.The pat ients were randomly divided into two groups by random number table method,which called TCM characterized chronic disease management group and control group.The control group were given conventional treatment.The TCM characterized chronic disease management group was combined with TCM characterized chronic disease management based on the contr ol group.The course of treatment was 24 weeks.The R software was used for statistical analysis,BMI,contr olled attenuation parameter(CAP)of the instantaneous elastic recorder(Fibroscan),blood lipid,glucose(GLU),liver function,and the SF-36 scale scores were used as evaluation indicators to compare the differences of each group before and after the test and compare the differences be tween two groups.ResultsA total of 120 patients have been enrolled in the study,3 patients were lost to follow-up,with 2 were lost in the control group,and 1 was lost in the TCM characterized chronic disease management group.The mean age of the remaining patients was 40.41±10.77 years,87 were males,and 30 were females.There were no significant differences in gender composition,age,education background,marital status,TCM constitution,level of NAFLD,and work-type between the control group and the TCM characterized chronic disease management(P>0.05),which were comparable.The BMI,CAP,TG,TC,HDL,LDL,GLU,ALT,AST,GGT(Gamma-glutamyl transpeptidase,GGT)of the patients in the control group did not change significantly(P>0.05),but The BMI,CAP,TG,TC,LDL,GLU,ALT,AST,and GGT of TCM characterized chronic disease management group were significantly lower than before the test(P<0.05).The decrease of BMI,CAP,TG,TC,LDL,GLU,ALT,GGT was statistically significant compared with those of the control group(P<0.05),and HDL was no statistically significant different between two groups(P>0.05).The scores of the SF-36 scale in the control group were not signi ficantly different from those before the trial(P>0.05).While the scores of role limitations due to physical health(RP),bodily pain(BP),general health perceptions(GH),and vitality(VT)in the TCM characterized chronic disease management group were significantly higher than those before the test(P<0.05).The analysis of the comparison results between groups showed that the improvement of the VT in the TCM characterized chronic disease management.group was significantly different compared with that in the control group(P<0.05).ConclusionTCM characterized chronic disease management can effectively reduce clinical indicators such as BMI,CAP value,blood lipid,GLU,and liver function in patients with NAFLD,and improve the quality of life of patients with NAFLD on RP,BP,GH,and VT.The effect provides some clinical evidence for the clinical application of TCM characterized chronic disease management. |
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