Systematic Reviews Of Randomized Controlled Trials By Beijing Tcm Differential Treatment In Chronic Obstructive Pulmonary Disease (stable Phase) In The Last Five Years

Chronic Obstructive Lung Disease(COPD) is one kind of common and frequent disease in Respiratory Diseases and still a major chronic disabling and deadly disease.Now COPD is a major public health problem in our country,which has seriously affected the people's health.In recent years the morbidity of COPD keeps a yearly increased tendency,while along with the dramatic decline of Cardiovascular Disease morbidity.According to our epidemiological survey, COPD causes 1million mortality a year.Respiratory diseases(mainly COPD) are the fourth leading cause of death in city and the first leading cause of death in rural area.At present,COPD lakes of specific drug in sake of its'various pathogenic factors and western medicine has relatively large toxic and side effects. Traditional Chinese Medicine has original priority in the treatment of COPD,and Stable-COPD related clinical research has become a hotspot in recent years.The efficacy and safety of TCM has been accepted preliminary in clinic.This study follows the principle of EBM and uses the methods and means of systematic review to evaluate RCT about Stable-COPD curing with TCM syndrome differentiation and treatment systematically in five years lately,to analysis questions exist in TCM intervention towards COPD in Beijing area,and to provide reference for the practice of EBM in TCM intervention towards COPD.This paper is divided into two parts:literature review and systematic review1.Literature Review:firstly,to summarize etiology and pathogenesis, syndrome research,therapeutic principle and method and etc from TCM understanding and research,and to analysis TCM research status,treatment characteristics and therapeutic advantages of COPD comprehensively. Secondly,to summarize the definition,risk factors and pathogenesis,path physiology,diagnosis,grade and stage,prevention,treatment and etc of COPD from understanding and research of western medicine,and to expound COPD research status of modern medicine.2.Systematic Review:study on evaluation of RCT about Stable-COPD curing with TCM syndrome differentiation and treatment systematically in Beijing areaObjects:To evaluate the efficacy and safety about Stable-COPD curing with TCM syndrome differentiation and treatment systematically,and to analysis questions exist in TCM intervention towards COPD in Beijing area.Methods:①Retrieval Strategy:To carry out electronic retrieval from CBM disc,CNKI disc,VIP disc,CMCC disc,CMAC disc,CDDB disc,CACP disc,The Cochrane Library,Pubmed and OVID database using subject words like Chronic Obstructive Lung Disease or Traditional Chinese Medicine,to carry out manual retrieval from proceeding of domestic respiratory disease,and to identify reference from article related appendix as supplement retrieval.All search Date bake from Jan.2003 to Dec.2008.②Literature Evaluation:Tow researchers carried out literature screening independently According to the inclusion and exclusion criteria.Different ideas handled by the third party.We acquired characteristic data from related literature studies,and evaluated the methodology and report quality of RCT in accord with inclusion criteria.Meta analysis was by Revman4.2.9 software.Results:The total number of literatures searched was 2061,368 literatures existed after exclude repeated report actually,after selected literatures whose author's work unit was in Beijing,finally 3 RCTs were included with a total patients number of 261.The general methodology and report quality of all the trials were relatively low.According to Meta-analysis,There was no significance difference between combined routine western medicine and tonify lung and active blood group and routine western medicine group,and was no significance difference between combined routine western medicine and syndrome differentiation and treatment of TCM group and combined routine western medicine and TCM group on clinical effect.There was no significance difference between combined routine western medicine and syndrome differentiation and treatment of TCM group and combined routine western medicine and TCM group on therapeutic effect of syndrome.There was a trend of more effective of combined routine western medicine and syndrome differentiation and treatment of TCM group compared with combined routine western medicine and TCM group on total effective rate[RR:1.16,95%CI(0.98,1.38),P=0.09].Combined routine western medicine and TCM group was superior to control group on the improvement of FVC[WMD:0.52,95%CI(0.49,0.55),P＜0.01].Combined routine western medicine and syndrome differentiation and treatment of TCM group was superior to combined routine western medicine and TCM group on the improvement of FEV₁[WMD:0.49,95%CI(0.43,0.55).Combined routine western medicine and tonify lung and active blood group was similar to routine western medicine group but the result was not consistent with sensitivity analysis. Combined routine western medicine and syndrome differentiation and treatment of TCM group was superior to combined routine western medicine and TCM group on the improvement of FEV₁%[WMD:7.31,95%CI(6.77,7.85),P＜0.01]. Combined routine western medicine and tonify lung and active blood group was superior to routine western medicine group on the improvement of MVV[WMD: 7.00,95%CI(6.66,7.34),P＜0.01].Combined routine western medicine and syndrome differentiation and treatment of TCM group was superior to combined routine western medicine and TCM group on the improvement of PO₂,PCO₂[PO₂, WMD:0.75,95%CI(0.63,0.87),P＜0.01;PCO₂,WMD:0.85,95%CI(0.78, 0.92),P＜0.01].Combined routine western medicine and tonify lung and active blood group was superior to routine western medicine group on the improvement of IL-1[WMD:-0.12,95%CI(-0.15,-0.09),P＜0.01].Combined routine western medicine and syndrome differentiation and treatment of TCM group was similar to combined routine western medicine and TCM group on the improvement of WBC. All the research did not see any adverse reactions.Conclusion:Combined routine western medicine and TCM group can improve therapeutic effect of syndrome of TCM,lung function index and the level of some inflammatory mediators,and do not see any adverse reactions in short-term.This systematic review identifies very limited RCT,inconsistency exists in measurement index,prognostic factors maldistribution,study time are not unified,follow-up time are not enough,the exiting of potential publication bias, detection and report of adverse reactions are below standard,therefore,we cannot have exact conclusion towards the validity and safety on TCM treatment of COPD, more high quality RCTs in this field are required to verify results.