A Systematic Review Of The Efficacy And Safety Of Shugan Lidan Method Combined With Western Medicine In Treating Chronic Cholecystitis

Objective:Meta-analysis was used to evaluate the efficacy and safety of Shugan Lidan method combined with Western medicine in the treatment of chronic cholecystitis.It provides powerful evidence-based medical data for the treatment of chronic cholecystitis with traditional Chinese medicine andpromotes Chinese medicine culture.Methods:Search Knowledge Network,China Biomedical Literature Database,Wanfang Database,VIP Database,Pubmad Database,Cochrane Library,Embase Database and Manual Search(time to January 1,2019),screening randomized controlled trials(RCTs)meeting inclusion criteria According to the criteria for measuring risk of bias in the Cochrane System Evaluator' s Handbook,the risk of biased risk assessment was included in the included studies,data was extracted and Meta-analysis and systematic review were performed using Review Manager 5.3.Result:1.13 RCTs mentioned the cure rate,There was homogeneity among the studies.The cure rate of chronic cholecystitis was higher than that of traditional Western medicine,and the method of treating liver and gallbladder combined with western medicine was higher than 1.77 times of conventional western medicine(Z=7.80,P<0.00001),RR=1.77(1.54,2.05).2.All the 14 studies reported on the efficiency,heterogeneity test showed no heterogeneity.Compared with the simple application of Western medicine routine Treatment,Shugan Lidan method combined with Western medicine routine treatment of chronic cholecystitis is more effective,1.23 times more than the traditional application of Western medicine(Z=9.11,P<0.00001),RR=1.23(1.18,1.29)3.Three RCTs reported the occurrence of adverse reactions(including skin itching,nausea and vomiting,rash,etc.),and the homogeneity between the groups was good.The meta-analysis showed no significant difference in the incidence of adverse reactions between the two groups(Z=1.03,P=0.31>0.05),RR=0.72,(0.38,1.36).4.Three RCTs in 14 studies observed changes in gallbladder wall thickness before and after treatment.Heterogeneity examination suggested greater heterogeneity.Three RCTs were subgrouped.Subgroup 1 was included in two study groups without heterogeneity.(Chi2=0.07,P=0.79,I2=0%),subgroup 2 included 1 study,heterogeneity between groups(Chi2=4.03,P=0.04,I2=75.2%),using random effects model,statistics The results suggest(Z=25.98,P<0.00001),MD=-0.73(-0.81,-0.65),suggesting that the combination of Shugan Lidan method and Western medicine can reduce the thickness of gallbladder wall compared with western medicine.5.Three RCTs in 14 studies observed changes in gallbladder systolic function before and after treatment.The heterogeneity test results indicated that the heterogeneity between groups was low.Meta-analysis results(Z=23.64,P<0.00001),MD=14.28(13.10,15.47),with significant differences,suggesting that Shugan Lidan combined with Western medicine can effectively promote the recovery of gallbladder function.6.Three RCTs in 14 studies observed changes in serum leptin(LEP)before and after treatment.The heterogeneity test showed no heterogeneity.Meta-analysis results(Z=13.70,P<0.00001),MD=-1.34(-1.53,-1.15),with significant differences,suggesting that Shugan Lidan combined with Western medicine can effectively reduce serum LEP levels in patients.7.Three RCTs in 14 studies observed serum tumor necrosis factor-?(TNF-a)levels before and after treatment.Heterogeneity test results indicated greater heterogeneity.The authors of one study performed statistics on serum TNF-a levels.The description is inconsistent with the data recorded by the author.After knocking out the results,the homogeneity between the groups is good,the meta-analysis results(Z=7.05,P<0.00001),MD=-6.60(-8.43,-4.76),suggesting Shuganli Cholesterol combined with Western medicine can reduce serum TNF-a levels in patients with chronic cholecystitis.8.Descriptive analysis of index results:1 RCT in 14 studies used the McGill pain questionnaire to score patients,including VAS score,PRI score,PPI score,and significant differences between groups(P<0.05).Liver gallbladder combined with Western medicine may improve patients' VAS score,PRI score,PPI score.9.Two RCTs in 14 studies reported recurrence after treatment,with good homogeneity between groups,meta-analysis results(Z=4.74,P<0.00001),RR=0.27(0.16,0.46),significant differences The above two RCTs suggest that Shugan Lidan combined with Western medicine may effectively reduce the recurrence rate of patients.10.Eight of the 14 studies reported TCM symptom scores,because three RCTs were not included in the continuous variables.Five RCTs were included to evaluate abdominal pain and right upper quadrant tenderness.Intergroup heterogeneity Larger,subgroup analysis,abdominal pain:subgroup 1 included 2 studies,low heterogeneity within the group(Chi2=0.30,P=0.58,12=0%),subgroup 2 included 1 study,sub Group 3 included 2 studies with low heterogeneity within the group(Chi2=0.30,P=0.88,I2=0%),heterogeneity between subgroups(Chi2=,95.47,P<0.00001,I2=97.9%),random effects model,meta-analysis results(Z=9.59,P<0.00001),MD=-0.95(-1.15,-0.76),significant differences;right upper quadrant tenderness subgroup 1 included 2 studies,heterogeneity within the group Low(Chi2=0.04,P=0.85,I2=0%),subgroup 2 included in one study,high heterogeneity between groups(Chi2=111.08,P<0.00001,12=99.1%),selection of random effects model Meta analysis of combined effect(Z=4.47,P<0.00001),SMD=-10.08(-14.50,-5.66),there are significant differences;the above two statistical results suggest that Shugan Lidan combined with Western medicine may be effective drop Low patient TCM symptom score(abdominal pain,right upper quadrant tenderness).11.Rule analysis shows that the formulas,licorice,radix paeoniae alba,radix bupleuri,money grass rhubarb is a high frequency of the five traditional Chinese medicine,commonly used drugs in the radix paeoniae alba,radix bupleuri,licorice,radix bupleuri,radix bupleuri,radix et rhizoma rhei,radix bupleuri,money grass ",etc.Conclusion:The current evidence supports that the efficacy of Shugan Lidan method combined with Western medicine in the treatment of chronic cholecystitis is better than the traditional application of Western medicine,but more high-quality RCT is needed to improve the level of research.