Meta Analysis Of Randomized Controlled Trials Of Xijiao Dihuang Decoction In Treating Henoch-schonlein Purpura In Children

Objective:In this paper,the clinical efficacy and safety of Xijiao Dihuang decoction in the treatment of Henoch-Schonlein purpura in children were evaluated by systematic review and Meta analysis,in order to provide research basis and guidance for the clinical efficacy of Henoch-Schonlein purpura and the pharmacological study of Xijiao Dihuang decoction.Method : Through the China knowledge Network database(CNKI),Wanfang database(Wanfang),Chongqing VIP Chinese sci-tech periodical database(VIP),Chinese biomedical literature service system(CBM),Pub Med,Embase,Cochrane Library seven major databases searched on the World wide Web,the search time is from the establishment of the database to January 31,2021.A systematic and comprehensive search was conducted on the randomized controlled trial of Xijiao Dihuang decoction in the treatment of Henoch-Schonlein purpura in children.And two evaluators strictly according to the inclusion and exclusion criteria for literature screening,extraction data,and the quality of the literature evaluation,using Rev Man5.3 software for Meta analysis.Result:A total of 23 clinical randomized controlled trials were included,including 2179 patients,1002 patients in the rhinoceros horn Dihuang decoction combined with western medicine routine treatment group and 935 patients in the control group.133 patients in the treatment group and 109 patients in the control group were treated with Xijiao Dihuang decoction alone.The results of Meta analysis showed that the total clinical effective rate(OR=5.85,95%CI[4.12,8.30],Z=9.87,P < 0.00001),clinical cure rate(OR=2.24,95%CI[1.72,2.91],Z=5.99,P < 0.00001),Ig G level(WMD=1.29,95%CI[0.48,2.09],Z=3.14,P=0.002 < 0.01)and CD4+/CD8+(WMD=0.29,95%CI[0.20,0.38],Z=6.27,P<0.00001)in children with Henoch-Schonlein purpura treated by Xijiao Dihuang decoction combined with western medicine were higher than those in western medicine,and it had obvious advantages in shortening the disappearance time(OR=0.28,95%CI[0.12,0.67],Z=2.85,P=0.004< 0.01)and reducing the recurrence rate of purpura(WMD=-5.13(95%CI[-8.54,-1.72],Z=2.95,P=0.003<0.01),abdominal pain(WMD=-1.30,95%CI[-2.18,-0.43],Z=2.93,P=0.003 < 0.01),arthralgia(WMD=-4.36,95%CI[-6.76,-1.96],Z=3.55,P=0.0004<0.01),digestive tract symptoms(WMD=-2.06,95%CI[-3.47,-0.65],Z=2.87,P=0.004 < 0.01),rash(WMD=-2.79,95%CI[-4.43,-1.15],Z=3.33,P=0.0009<0.01)and so on.It could significantly reduce the level of Ig A(WMD=-0.41,95%CI[-0.59,-0.23],Z=4.48,P<0.00001),IL-10(SMD=-1.37(95%CI[-1.73,-1.01],Z=7.45,P<0.00001)、CD8+T%(WMD=-3.20,95%CI[-4.87,-1.52],Z=3.75,P=0.0002<0.01)in children with Henoch-Schonlein purpura.However,there was no significant difference in the incidence of adverse reactions,Ig M level,tumor necrosis factor-α level and CD4+T% between the two groups.Compared with the routine treatment of western medicine,rhinoceros horn Dihuang decoction alone can significantly improve the total clinical effective rate(OR=3.54,95%CI[1.44,8.73],Z=2.75,P=0.006<0.01)and cure rate(OR=2.31,95%CI[1.32,4.04],Z=2.94,P=0.003<0.01).Conclusion : Xijiao Dihuang decoction in the treatment of Henoch-Schonlein purpura in children is better than the routine treatment of western medicine,the clinical efficacy,physical and chemical indicators have been effectively improved.However,because most of the original literatures have defects such as high risk of bias,small sample size,and the loss or insufficiency of clinical laboratory indicators,symptom scores,quality of life scores,pain scores and other indicators,it is suggested that while strictly standardizing the diagnostic criteria and clinical efficacy criteria,we should use better allocation scheme hiding and random sequence generation methods,and use blind methods as far as possible.During the follow-up,we pay attention to the integrity of the reporting indicators,and on the basis of the above,we continue to carry out clinical randomized controlled trials with large sample size,multi-center combination and rich outcome indexes.in order to increase the intensity of the evidence of Xijiao Dihuang Decoction in the treatment of Henoch-Schonlein Purpura in children,and lay a foundation for the clinical development of this therapy on a large scale.