Meta-analysis And GRADE Evaluation Of The Clinical Curative Effect Of The Method Of Activating Blood And Removing Blood Stasis In The Treatment Of Diabetic Retinopathy

Purpose:Evaluate the clinical efficacy and safety on treating DR by the method of promoting blood circulation and removing blood stasis.Method:Design reasonable and effective way of retrieval according to the research purpose.Retrieving papers from Pub Med,Embase,The Cochrane Library,China national knowledge infrastructure(CNKI),Wanfang Data(WF),Weipu database(VIP)and China biology medicine(CBM).Retrieval time from January 1990 to December 2017.The study contained thirty-nine RCTs,including 4800 patients.2504 patients were in experimental group and 2296 ones were in control group.Rev Man 5.3 software was used for data analysis,processing and evaluation.The main outcomes included clinical efficiency,Vision,fundus,hemorheology.The evidence evaluation and recommendation GRADE standards was used for quality evaluation.Results: 1.Treating DR by the method of Promoting blood circulation and removing blood stasis: experimental group was better than control group in global clinical efficiency.[OR=3.13,Z=14.50,P<0.00001,95%CI(2.69,3.66)].Each funnel plot was approximately symmetrical.2.The clinical efficiency of treating DR by the method of Promoting blood circulation and removing blood stasis alone:experimental group was better than control group[OR=3.09,Z=9.65,P<0.00001,95%CI(2.46,3.89)];The clinical efficiency of treating DR by the method of integrate traditional and western medicine:experimental group was better than control group [OR=3.16,Z=9.77,P<0.00001,95%CI(2.51,3.97)];Comparison among groups:OR(the method of promoting blood circulation and removing blood stasis+Western medicine)>OR(Western medicine).3.The clinical efficiency of treating DR by three route of administration : OR(iontophoresis)>OR(intravenous injection)>OR(oral administration)4.In terms of improving vision by the method of promoting blood circulation and removing blood stasis:experimental group was better than control group[OR=0.10,Z=7.49,P<0.00001,95%(0.07,0.12)].5.The clinical efficiency of fundus :experimental group was better than control group [OR=1.88,Z=3.07,P=0.002,95%(1.26,2.81)].6.In terms of decrease whole blood viscosity(high shear rate)by the method of promoting blood circulation and removing blood stasis :experimental group was better than control group[MD=-0.79,Z=6.79,P<0.00001,95%CI(-1.02,-0.56)];.In terms of decrease Whole blood viscosity(low shear rates):experimental group was better than control group[SMD=-1.11,Z=5.65,P<0.00001,95%CI(-1.49,-0.72)];.In terms of decrease Plasma viscosity:experimental group was better than control group[SMD=-1.47,Z=4.30,P <0.00001,95%CI(-2.14,-0.80)];.In terms of decrease hematocrit:experimental group was better than control group[SMD=-0.74,Z=6.79,P < 0.00001,95%CI(-0.96,-0.53)];.In terms of decrease Fibrinogen:experimental group was better than control group[SMD=-1.05,Z=6.05,P<0.00001,95%CI(-1.39,-0.71)].7.The grade of the quality of evidence is low.Conclusion: 1.The clinical efficiency of treating DR by he method of Promoting blood circulation and removing blood stasis was better than other therapies.2.The clinical efficiency of treating DR by integrated traditional and western medicine is better.3.Treating DR by the three kinds of method including iontophoresis,intravenous injection,oral administration,the clinical efficiency of iontophoresis is optimality.4.In improving eyesight and fundus.The clinical efficiency of treating DR by he method of Promoting blood circulation and removing blood stasis was better than other therapies.5.In reducing the Whole blood viscosity,Plasma viscosity,Hematocrit,Fibrinogen.The clinical efficiency of treating DR by he method of Promoting blood circulation and removing blood stasis was better than other therapies.6.Clinician should be careful of using the evidence for clinical decisions,because of the grade of the quality of evidence is low.