Systematic Evaluation And Meta-analysis Of The Effectiveness And Safety Of Chinese Medicine For Huoxue Huayu In Intervention Of Retinal Vein Occlusion

Objective:Traditional Chinese medicines for Huoxue huayu are widely used in the treatment of retinal vein occlusion,but there is a lack of high-quality and high-level clinical evidence-based evidence.This study intends to use the Meta analysis method to systematically review and meta-analyze the clinical randomized controlled literature of Chinese medicine for Huoxue huayu to intervene in retinal vein occlusion,in order to objectively evaluate the clinical effectiveness and safety of Chinese medicine for Huoxue huayu in intervention of retinal vein occlusion,Provide relatively reliable evidence-based medical evidence for treatment of retinal vein occlusion with traditional Chinese medicine.Methods:Two people respectively searched Pubmed,CBM,CNKI,Wanfang and other Chinese and English full-text databases.The search time was 2000-January 2020.The research object was patients with retinal vein occlusion.The intervention measure was that the treatment group must include Chinese medicine treatment which should be included Huoxue huayufa,and the control group must not be treated with traditional Chinese medicine.The study type is a clinical randomized controlled trial.According to the abstract and full text of the retrieved documents and the combination of inclusion and exclusion criteria or the literature is screened to exclude documents with low journal levels.If the opinions are not consistent,a third person is invited to discuss the decision and obtain the last included document.Use the Jadad scale to evaluate the quality of the initially screened literature,make a table to extract relevant data,and finally use Rev Man5.3 software to perform meta-analysis on clinical outcomes such as total clinical effectiveness,vision,retinal circulation time,central retinal thickness,hemorrheology,adverse reactions,TCM syndromes,and fundus bleeding absorption etc.If the heterogeneity is high,perform subgroup analysis and sensitivity analysis.Use the funnel chart to analyze the bias of the included literature.Result:A total of 368 documents were retrieved in this study,including 364 Chinese documents and 4 English documents,but the last 28 documents included were Chinese documents,of which 4 High-quality literature,24 low-quality literature.In terms of total clinical efficiency,Meta analysis showed that OR= 4.36,CI(3.27,5.83),Z=9.98(P < 0.00001).In terms of apparent efficiency,Meta analysis showed that OR=2.75,CI(2.20,3.44),Z= 8.85(p < 0.00001).In terms of vision,the meta-analysis showed that 1 month vision group: SMD=0.41,CI(-0.22,1.05),Z=1.27,P= 0.2;2months vision group: SMD= 0.32,CI(-0.32,0.96),Z=0.97,P=0.33;3 months vision group: SMD=0.12,CI(-0.30,0.54),Z=0.56,P=0.57;6 months group vision: SMD =-0.78,CI(-1.07,-0.49),Z= 5.24,P < 0.00001).In terms of retinal circulation time,Meta analysis results showed that SMD=-0.63,CI(-0.83,-0.42),Z= 5.91,P <0.00001.In terms of changes in central retinal thickness or central macular thickness,Meta analysis showed that 1 month CMT group: SMD=-0.93,CI(-1.65,-0.22),Z=2.58,P=0.010;2 month CMT group: SMD=-0.98,CI(-3.44,1.49),Z= 0.77,P=0.44;3 month CMT group: SMD=-1.06,CI(-1.54,-0.58),Z=4.34,P< 0.0001;6month CMT group:SMD =-1.10,CI(-1.35,-0.86),Z=8.78,P < 0.00001.In terms of hemorheology,Meta analysis showed that plasma viscosity group: MD=-0.31,CI(-0.60,-0.01),Z= 2.03,P= 0.04;fibrin value group:MD=0.39,CI(-0.54,-0.24),Z=5.12,P< 0.00001;erythrocyte aggregation index value group,MD=-0.24,CI(-0.31,-0.18),Z=7.38,P < 0.00001;whole blood viscosity high cut value grou: MD=-0.00,CI(-0.45,0.45),Z=0.01,P=0.99;whole blood viscosity low cut value group: MD=-1.93,CI(-2.44,-1.42),Z= 7.45,P < 0.00001.In terms of adverse reactions,Meta analysis showed that RR= 0.29,CI(0.06,1.36),Z= 1.57,P= 0.12.In terms of the total efficiency of TCM syndromes,Meta analysis showed that OR= 5.08,CI(2.45,10.52),Z=4.37,P<0.0001.In terms of the total effective rate of fundus hemorrhag,absorption,Meta analysis showed that OR= 3.35,CI(1.79,6.27),Z= 3.77,P= 0.0002.In terms of the total effective rate of improvement of fundus macular edema,Meta analysis showed that OR=5.23,CI(2.26,12.07),Z= 3.87,P=0.0001.In terms of total efficiencyof improvement of vision field,Meta analysis showed that OR= 3.70,CI =(1.72,7.98),Z=3.34,P=0.0008.Conclusion:Based on the systematic review and meta-analysis of the existing literature,we can see that in terms of curative effect,the Chinese medicine for Huoxue huayu may be more advantageous than the control group in improving clinical total efficiency and improving outcome indicators such as vision,visual field,macular edema,and hemorheology.It may play a comprehensive therapeutic effect in reducing blood viscosity,improving retinal blood circulation,promoting retinal hemorrhage,exudative absorption,reducing macular edema,improving visual function and TCM syndromes,and improving the quality of life of patients.In terms of safety,no serious adverse reactions have been found in the treatment of RVO with Chinese medicine for Huoxue huayu.The incidence of adverse reactions in the treatment group is lower than that of the control group,suggesting that the clinical safety of Chinese medicine for Huoxue huayu treatment may be relatively reliable.Because relatively few literatures are included in this systematic review,and the quality of the literature is relatively low,some of the outcome indicators are heterogeneous and the level of evidence is low,which has a great impact on this conclusion,so this conclusion needs more multi-center,Large sample of double-blind randomized controlled trials to verify before they can make more clear conclusions and recommendations.