Study Of Systematic Review Of Effectiveness Of Traditional Chinese Medicine Therapy In Treating Chronic Obstructive Pulmonary Disease At Stable Phase

Objective:Traditional Chinese medicine therapy has a long history.Because of its advantages of simple?convenient and Significant effect,it has been widely usedin clinic,and combined with modern medicine derived out mang new therapies.In recent years,despite the clinicalreports aboutcharacteristic therapeutics of traditional Chinese medicineappliedin the stable period of Chronic obstructive pulmonary disease increased year by year,and the Research results also showed a good therapeutic effect,reasons such as different qualities of the relevant clinical trials,different choices of the outcome indicators lead to inconsistencyin efficacy evaluation thus makingthe high level of evidence relatively lacking.This study used meta-analysis method to evaluate the clinical efficacy of traditionalChinese medicine therapy?Acupuncture,treating the winter's disease in summer,acupoints paste,acupoint injection,acupoint catgut embedding,breathingexercises?in treating stable COPD,summarize the outcome indicator and efficacy to provide the high-level evidence and guide clinical application.Methods:1 According to the Evidence-based Medicine and the Systematic Reviewof the PICOS principles,we has drawed up the retrieval terms and retrieval strategy,searched Wan Fang Database,CNKI,Cqvip,CSCD,Sino Med,Pub Med,and Cochrane Library,from database foundation to February 2017,and grey literatures includedwere retrieved,to acquire all the RCTs about the Traditional Chinese medicinetherapy in treating stable COPD,2 We can Screen out eligible documents according to the established inclusion and exclusion criteria,classificate the study according to the different characteristics of traditional Chinese medicine classification.3 The quality assessment of this study was conducted on the basis of the bias risk assessment tool produced by the Cochrane Collaboration.4 Meta-analysis was performed using Revman 5.3.Result:The article retrieved 4184 articles,and 121 articles were absorbed,including 10451 cases of patients.1 In the systematic review of acupuncture treatment in the COPD stable period,a total of 7 articles were included,including 398 cases.Meta analysis was performed from five aspects and the results showed that Compared with the simpleroutine treatment of Western medicine group,Western routine treatment added with acupuncture treatment group can increase the clinical efficiency[RR=1.16,95%CI?1.06,1.28?,P=0.002<0.01],improve the indexes of lung functio n examinations.FEV₁%[MD=1.98,95%CI?0.14,3.82?,P=0.04<0.01],FEV₁/FVC[SMD=0.47,95%CI?0.27,0.67?,P<0.00001<0.01],Improve symptom scores oftraditional Chinese medicine[SMD=-0.66,95%CI?-0.90,-0.42?,P<0.00001<0.01],improve the qualityof life[MD=-4.22,95%CI?-5.49,-2.95?,P<0.00001<0.01],but there was no significant difference in the 6minute walk test[MD=14.71,95%CI?-17.09,46.50?,P=0.36>0.05].2 In the systematic review of moxibustion treatment in the COPD stable Period,a total of 13 articles were included,including 956 cases.Meta analysis was performed from eight aspects and the results showed that Compared with the simple routine treatment of Western medicine group,Western routine treatment added with moxibustion treatment group can increase the clinical efficiency[OR=1.16,95%CI?1.89,9.02?,P=0.0004<0.01],improve the indexes of lung function examinationsFVC[MD=0.4095%CI?0.36,0.44?,P<0.00001<0.01],improve FEV1[MD=0.30,95%CI?0.25,0.35?,P<0.00001<0.01],improve FEV₁%[MD=7.65,95%CI?4.48,10.81?,P<0.00001<0.01],improve FEV1/FVC[MD=10.65,95%CI?9.92,11.39?,P<0.00001<0.01],namely,moxibustion plus Western medicine conventional treatment significantlyimproved lung function than a single conventional treatment of Western medicine.It can also improve symptom scores oftraditionalChinese medicine[MD=-2.42,95%CI?-3.12,-1.72?,P<0.00001<0.01],improvethequality oflife[MD=-4.22,95%CI?-5.49,-2.95?,P<0.00001<0.01],buttherewasno significantdifferenceinthe6minuteswalk test[MD=-36.1195%CI?16.11,56.10?,P=0.0004<0.01],Improveimmune function,CD3[MD=5.01,95%CI?3.55,6.46?,P<0.00001<0.01],CD4[MD=5.90,95%CI?4.54,7.26?,P<0.00001<0.01],CD8[MD=-3.05,95%CI?-3.98,-2.12?,P<0.00001<0.01],CD4/CD8[MD=0.20,95%CI?0.05,0.34?,P=0.007<0.01].3 In the systematic review of respiratory exercise treatment in the COPD stable period,a total of 12 articles were included,including 709 cases.Meta analysis was performed from three aspects and the results showed that Compared with the simple routine treatment of Western medicine group,Western routine treatment addedwith respiratory exercise treatment group canimprove lungfunction FEV₁%[MD=8.75,95%CI?3.74,13.77?,P=0.0006<0.01],FEV₁/FVC[MD=4.27,95%CI?1.40,7.14?,P=0.004<0.01],improve St.George Respiratory Questionnaire points[SMD=-1.08,95%CI?-1.35,-0.80?,P<0.00001<0.01],increase the walking distance of 6 minutes[MD=43.66,95%CI?31.09,56.22?,P<0.00001<0.01].4 In the systematic review of acupoint catgut embedding treatment in the COPD stable period,a total of 14 articles were included,including 1017cases.Meta analysis was performed from five aspects and the results showed that ComparedwiththesimpleroutinetreatmentofWesternmedicine group,Westernroutine treatment added with acupoint catgut embedding treatment can increase the clinical efficiency[0R=3.34,95%CI?2.04,5.46?,P<0.00001<0.01],but therewas no significant difference in the improvement of lung function.FEV₁[SMD=-0.02,95%CI?-0.21,0.18?,P=0.87>0.05],FEV_1/FVC[MD=2.34,95%CI?-3.92,8.59?,P=0.46>0.05],Improve symptom scores oftraditional Chinese medicine[MD=-1.10,95%CI?-1.27,-0.93?,P<0.00001<0.01],improve the qualityof life[[MD=-0.36,95%CI?-0.60,-0.13?,P=0.002<0.01],increase the walking distance of 6 minutes[MD=27.06,95%CI?17.54,36.59?,P<0.00001<0.01].5 In the systematic review of acupoint injection treatment in the COPDstable period,a total of 16 articles were included including 1111 cases.Meta analysis was performed from three aspects and the results showed that Compared with the simple routine treatment of Western medicine group,Westernroutine treatment added with acupoint injection treatment group can increase the clinical efficiency[0R=4.0695%CI?2.76,5.98?,P<0.00001<0.01],improve lung function FVC[MD=0.44,95%CI?0.31,0.58?,P<0.00001<0.01],FEV₁[SMD=0.64,95%CI?0.37,0.91?,P<0.00001<0.01],FEV₁%[MD=7.68,95%CI?4.68,10.67?,P<0.00001<0.01],FEV₁/FVC[MD=9.36,95%CI?6.70,12.02?,P<0.00001<0.01],improve the qualityof life[MD=-5.01,95%CI?-7.54,-2.48?,P=0.0001<0.01].6In the systematic review of acupoints treatment in the COPD stable period,a total of 59 articles were included including 6260 cases.Meta analysis was performed from nine aspects and the results showed that Compared with the simple routine treatment of Western medicine group,Westernroutine treatment added with acupoints treatment group can increase the clinical efficiency[0R=3.73,95%CI?3.02,4.60?,P<0.00001<0.01],improve lung function,FVC[SMD=1.01,95%CI?0.55,1.46?,P<0.0001<0.01],FEV1[SMD=0.85,95%CI?0.58,1.12?,P<0.00001<0.01],FEV₁%[SMD=0.91,95%CI?0.48,1.34?,P<0.0001<0.01],FEV₁/FVC[SMD=0.43,95%CI?0.30,0.56?,P<0.00001<0.01],namely,acupoints plus Western medicine conventional treatment significantly improved lung function than a single conventional treatment of Western medicine.It can also improve St.George Respiratory Questionnaire points[MD=-12.41,95%CI?-19.74,-5.08?,P<0.00001<0.01],Improve symptom scores of traditional Chinese medicine[SMD=-0.6995%CI?-0.92,-0.43?,P<0.00001<0.01],improve the quality of life[MD=-0.27,95%CI?-0.45,-0.08?,P=0.006<0.01],reduce the number of acute attacks[SMD=-0.87,95%CI?-1.17,-0.57?,P<0.00001<0.01],increase the walking distance of 6 minutes[MD=12.71,95%CI?5.92,19.50?,P=0.0002<0.01],improve PEF[SMD=0.49,95%CI?0.25,0.74?,P=0.0001<0.01],reduce the BODE index[SMD=-0.37,95%CI?-0.66,-0.09?,P=0.01<0.05].Conclusion:1 The results showed that comparing with conventional Western medicine,all ofthe 6 kinds of therapy plus Western medicine conventional treatment can improve the clinical efficacy of patients;Acupuncture,moxibustion,breathing exercises,acupointinjection,acupointtreatmentcanimprovethelung function;AcupointcatgutembeddingplusWesternmedicineroutine improvement of lungfunction is not superior to the conventional treatment of conventionalWesternmedicine;Acupuncture,moxibustion,acupointcatgut embedding,acupointapplicationcanreducetheCOPDpatientsTCM syndrome;Acupuncture,acupoint catgut embedding,acupoint injection,acupoint application can improve the quality of life of patients;Moxibustion,breathing exercises,acupoint catgut embedding,acupointapplication can improve 6minutes walking distance;Acupuncture plus Westernmedicine routine 6 minutes walking distance improve ment is not better than the simple routine treatment of Western medicine;Moxibustion plus western medicine routine immune function is better than Western medicine routine;Acupoint application can also increase the patient's maximum expiratory flow rate,reduce the BODE index.2 Traditional Chinese medicine therapy combined with Western medicine routin-e treatment is better than simple routine treatment of Western medicine on the efficacy in the treatment of COPD stable period,which is also a effective treatment plan of Integrated Traditional Chinese and Western Medicine in the COPD stable period.Different therapies have different therapeutic effects.It is suggested that clinicians should choose appropriate Chinese medicine special therapy or joint application according to the different indicators of clinical outcome and individual differences.3 The overall quality of the literature included in this study is not high and may affect the credibility of the findings.We should look at this result cautiously and expect higher level of clinical trials to be included in the Meta-analysis to improve the level of evidence.