Meta-analysis Of Clinical Randomized Controlled Trial On The Treatment Of Ulcerative Colitis With Acupuncture And Traditional Chinese Medicine

Objective:Comprehensive collection of literature on acupuncture and traditional Chinese medicine and comparison of western medicine alone in the treatment of ulcerative colitis,and selected clinical randomized controlled trials that meet the requirements.To systematically evaluate the clinical efficacy and safety of acupuncture combined with traditional Chinese medicine in the treatment of UC,and to provide theoretical basis for acupuncture combined with medicine in the treatment of UC.Method:Find all the literatures that meet the inclusion requirements in the relevant medical databases such as CNKI and Pubmed from the self-built database to December 31,2020.Cochrane risk bias assessment tools and Jadad scale were used to evaluate the quality of the literature.Meta analysis was carried out with Review manager5.3 and stata14.0 software.A total of 23 RCT articles were included,involving 1882 patients,including 949 patients in the treatment group(acupuncture combined with traditional Chinese medicine group)and 933 patients in the control group(western medicine group).In terms of clinical efficacy,the total effective rate of UC in the treatment group was 95.02%(801/843),while that in the control group was 77.20%(640/829).The overall test effect value was Z= 9.81(p < 0.00001),OR=5.79,95%CI= [4.08,8.22].It is suggested that acupuncture combined with traditional Chinese medicine is effective in the treatment of UC.In terms of cure rate,Meta-analysis results showed that the cure rate of the treatment group was 49.5%(345/697),and that of the control group was 28.8%(197/683),OR=2.80,95%CI=[1.99,3.92],and the overall test effect value was Z=5.97(P < 0.00001).It was suggested that the cure rate of the acupuncture group was higher than that of the western medicine group.In terms of the efficacy of enteroscopy,Meta analysis showed that the efficacy of enteroscopy was 96%(105/109)in the treatment group,70%(77/110)in the control group,OR=8.67,95%CI= [2.97,25.34].The overall effective value was Z=3.95(P < 0.0001),suggesting that the combination of acupuncture and traditional Chinese medicine in endoscopic efficacy has a better effect.The results of serum tumor necrosis factor-α(TNF-α)study showed that Z=3.84(p=0.0001),SMD=-0.85,95%CI= [-1.29,-0.42].There was significant difference between acupuncture and medicine group and western medicine group.It is suggested that the outcome index of TNF-α after acupuncture combined with traditional Chinese medicine is better than that of western medicine alone.The results of serum interleukin-8(IL-8)Result:showed that SMD=-1.65,95%CI=[-3.56,0.27],Z=1.68(P =0.09),which was statistically significant between the treatment group and the control group,suggesting that the outcome index of IL-8 was better for the treatment of UC with acupuncture of traditional Chinese medicine.In terms of safety,five articles observed safety indicators.The incidence of adverse reactions in the treatment group was 0.51%,while the incidence of adverse reactions in the control group was 17.7%.The overall test effect value Z=3.53(P=0.000 < 0.05),OR=0.08,95%CI=[0.02,0.33],It suggested that the incidence of adverse reactions in the treatment of UC with acupuncture and medicine was low and the safety was good.Statistical analysis of intervention measures shows that in the treatment of UC with acupuncture of traditional Chinese medicine at present,meridians and acupoints(top 10)are usually selected as follows: Foot yangming meridian-Shangxiajuxu and Zusanli,Foot taiyin meridian-Yinlingquan and Sanyinjiao,Renmai-Shuifen,Tianshu,Qihai and Zhongwan,Foot taiyang meridian-Pishu;The high-frequency(top 10)traditional Chinese medicines used were: Coptis chinensis,Phelendron phelloides,Sophora flavescens,Baitouweng,Ash bark,Licorice,Atractylodes,Codonopsis,Radix Alba,Sanguisorba and Coix seed.Conclusion:This Meta analysis suggested that acupuncture with traditional Chinese medicine in the treatment of UC could improve the clinical efficacy,cure rate,colonoscopy efficacy,and reduce the levels of TNF-α and IL-8,with a low incidence of adverse reactions and good safety.Although there are some shortcomings,such as the overall quality of article is not high,there are no clinical studies comparing the combination of acupuncture and TCM with western drugs such as immunosuppressant and biological agents,but they still have certain guiding significance for clinical practice,In the future,large-sample,multi-center,high-quality randomized controlled trials are needed to provide further evidence of the efficacy and safety of the combination of acupuncture and traditional Chinese medicine in the treatment of UC.