| Objective:At present,the research of aplastic anemia?AA?by various Chinese medical scientists is controversial,but there is no unified diagnosis and treatment standard,which restricts the promotion and application of traditional medicine in the treatment of AA.Therefore,by collecting clinical data of AA and literature data of randomized controlled trial?RCT?,this study analyzed the relationship between traditional Chinese medicine?TCM?syndrome types and relevant specific objective indicators,discussed the distribution law of TCM syndrome types,and analyzed the clinical efficacy of TCM in the treatment of AA.In order to make the differentiation of AA more objective,and then conducive to the development of a unified standard of syndrome differentiation,to provide a reliable basis for clinical treatment,for the Chinese medicine treatment of AA synergistic use of clinical practice to provide a certain objective medical basis.Method:1.According to include exclusion standard to collect clinical cases,according to the diagnostic criteria of TCM AA syndrome differentiation can be divided into kidney yin deficiency type,kidney Yang deficiency type,Yin and Yang deficiency type,fire flourishing from Yin deficiency type,heat-toxin congestion and excessiveness type five types,by two investigators to fill in the patients with general situation and the syndrome information table,when investigators opinion in accordance,ask for instructions superior doctors for arbitration.The Boruta algorithm,multi-class logistic regression,and decision tree were used to establish Parametric and non-parametric models of influencing factors of TCM syndromes.Data were statistically processed using R3.6.0software.2.Search the CNKI,Wan Fang Data,Pub Med,The Cochrane Library,and EMbase databases built to November 2019 to find RCTS on the treatment of AA with TCM,According to the inclusion and exclusion criteria,literature was searched,and two researchers independently screened the literature,extracted the data,and cross-checked.In case of disagreement,a third investigator may decide by discussion.Data extraction and quality evaluation were carried out for the selected included studies,and R3.6.0and Rev Man5.3 software were used for Network Meta-analysis.Results:?.The influence of TCM AA syndrome classification of relevant factors:1.AA patients were included in a total of 98 cases,mainly middle-aged and elderly people aged 50 to 80.The incidence of adolescent patients?under 20 years of age?is much higher than that of men,and the patients have a longer course of disease,all four seasons can come on to the winter is the most obvious and fever is not typical.2.In AA,the proportion of TCM syndrome type from large to small was Yin and Yang deficiency type?29.6%?>kidney Yin deficiency type?22.4%?=kidney Yang deficiency type?22.4%?>fire flourishing from Yin deficiency type?16.3%?>heat-toxin congestion and excessiveness type?9.2%?.3.The inpatient platelet count of AA patients was inversely proportional to the incidence of fire flourishing from Yin deficiency type,and positively proportional to the incidence of kidney Yin deficiency type.The prothrombin time was inversely proportional to the incidence of Yin and Yang deficiency type and positively proportional to the incidence of heat-toxin congestion and excessiveness type.4.Compared with patients with AA with a short course of disease,as the inpatient's platelet count of a patient with a long course of disease increases,the probability that the type of TCM syndrome type is kidney Yin deficiency type becomes higher;the higher the patient's course,the lower the inpatient's platelet count,the lower the probability of TCM syndrome type being kidney yang deficiency type;the higher the patient's disease course,the greater the inpatient's platelet count,the lower the probability that the TCM syndrome type is Yin and Yang deficiency type;the relationship between the inpatient's platelet count and the course of the disease was not obvious in the patients with fire flourishing from Yin deficiency type and heat-toxin congestion and excessiveness type.5.Results of multivariate logistic regression of influencing factors of Chinese syndrome type of AA were as follows:inpatient's platelet count P=0.00159,the time of prothrombin P=0.00074,and inpatient's platelet count*course of disease P=0.02010,all<0.05,with statistically significant differences,were effective indicators affecting the Chinese medicine syndrome type of AA.6.Results of decision tree analysis of influencing factors of Chinese syndrome type of AA were as follows:when the inpatient's leukocyte count for AA was<0.835*1012/L,the tape of heat-toxin congestion and excessiveness tape had the highest probability,accounting for 71%.Patients were satisfied with inpatient's leukocyte count<5.595*1012/L and?0.835*1012/L,inpatient's platelet count?14*109/L,diastolic blood pressure?60.5 mm Hg,prothrombin time?10.85s,and when the onset season was spring or winter,the classification of kidney Yang deficiency tape had the highest probability,accounting for 72%.When the inpatient's leukocyte count was?0.835*1012/L,the inpatient's platelet count was?7.5*109/L,and the diastolic blood pressure was<60.5mm Hg,the classification of kidney Yin deficiency type had the highest probability,accounting for 58%.When the inpatient's leukocyte count was?0.835*1012/L and the inpatient's platelet count was<7.5*109/L,the classification of fire flourishing from Yin deficiency type had the highest probability,accounting for 58%.When the inpatient's leukocyte count?5.595*1012/L,the inpatient's platelet count?14*109/L,diastolic blood pressure?60.5 mm Hg,and prothrombin time?10.85s,the classification of Yin and Yang deficiency type had the highest probability,accounting for 71%.?.Results of Network Meta-analysis on the treatment of AA with TCM:A total of 63 RCTs were involved,involving 4083 patients,13 Chinese medicines:Fu fang zao fan Pills?FFZFP?,Shen mai injection?SMI?,Huang qi injection?HQI?,Shen fu injection?SFI?,Qing kai ling?QKL?,Xue fu sheng?XFS?,Fu zheng bu xue granules?FZBXG?,Bu sui sheng xue granules?BSSXG?,Zi sui sheng xue caplsules?ZSSXC?,Bu sui hua sui granules?BSHSG?,Shu di duo tang oral solution?SDDTO?,Yang xue sheng sui decoction?YXSSD?,aplastic anemia decoction?AAD?.Random effect meta-analysis results:Compared with conventional therapy alone,traditional Chinese medicine combined with conventional therapy can better improve clinical effectiveness?RR=1.35,95%CI[1.29,1.42],P<0.00001?.Network Meta-analysis results:Compared with conventional therapy alone,traditional Chinese medicine combined with conventional therapy can better improve clinical effectiveness;FFZFP?OR=5.15,95%CI[3.73,7.03]?combined with conventional treatment can better improve clinical effectiveness,which the most likely to be the best choice for treatment?SUCRA accounted for 84%?;AAD?OR=33.56,95%CI[18.44,48.49]?combined with conventional treatment can better improve the decline of hemoglobin count,which the most likely to be the best choice for treatment?SUCRA accounted for 100%?;AAD?OR=86.36,95%CI[73.57,99.04]?combined with conventional treatment can better improve the decline of platelet count,which the most likely to be the best choice for treatment?SUCRA accounted for 95%?;BSSXG?OR=5.91,95%CI[2.79,9.1]?,combined with conventional treatment can better improve the decline of white blood cell count,which the most likely to be the best choice for treatment?SUCRA accounted for 100%?;YXSSD?OR=1.2,95%CI[0.57,1.81]?,combined with conventional treatment can better improve the decline of white blood cell count,which the most likely to be the best choice for treatment?SUCRA accounted for 79%?.Conclusion:1.AA patients are mostly middle-aged and elderly,Adolescent women have a higher incidence of disease than men,and the patients have a longer course of disease,all four seasons can come on to the winter is the most obvious and fever is not typical;There is a certain regularity in the distribution of TCM syndromes in AA;There is a certain interaction between the inpatient's platelet count and the course of AA patients;there is a potential correlation between inpatient's platelet count,prothrombin time,inpatient's leukocyte count,diastolic blood pressure,disease season and TCM syndromes of patients with AA,it can be used as a reference for TCM clinical diagnosis and treatment of AA.2.Compared with conventional treatment,TCM combined with conventional treatment can improve the clinical effectiveness of AA.It has an advantage in improving the decline of hemoglobin count,platelet count,white blood cell count,and white blood cell count;among them,FFZFP,AAD,BSSXG,YXSSD deserves special attention,for the treatment of this disease,the TCM supplemented with conventional treatment is a priority.However,the effects of different TCM have different focuses,and they should be appropriately selected according to different treatment purposes types of TCM. |
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