| Objective:The Meta-analysis method is used to evaluate the clinical efficacy and safety of Huaiqihuang Granules combined with conventional Western medicine in the treatment of children with allergic purpura,and provide certain evidence-based medical evidence for clinical treatment.Methods:A comprehensive search of major Chinese and English databases at home and abroad from the establishment of the database to July 2020,such as Pubmed,Wos,EMbase,China Knowledge Network(CNKI),Wanfang,VIP(VIP),China Biomedical Network(CBM),etc.Find out all the clinical randomized controlled trials(RCT)related to Huaiqihuang Granules combined with conventional Western medicine in the treatment of children with allergic purpura.Two researchers were selected to screen the literature based on inclusion criteria and exclusion criteria.The two people independently assessed the risks of the included literature according to the requirements of the Cochrane system review,extracted valid data,summarized the literature data into an Excel table,and cross-confirmed after completion.The improved Jadad score sheet was used to evaluate the quality of the included literature,Stata 15.0 and Rev Man 5.3 software were used to conduct a Meta analysis of the outcome indicators,and the quality of the evidence was evaluated according to GRADE standards.Result:1.A total of 14 randomized controlled trials were screened according to the criteria for inclusion and exclusion.The improved Jadad score was used to evaluate their quality and found5 high-quality documents,and the rest were low-quality documents.2.Analysis of outcome indicators:(1)The total effective rate of Huaiqihuang Granules combined with conventional Western medicine in the treatment of children with allergic purpura(RR=1.25,95%CI[1.17,1.34],P<0.00001),recurrence rate(RR=0.29),95%CI[0.16,0.52],P<0.0001),CD3~+(SMD=0.95,95%CI[0.57,1.34],P<0.00001),CD4~+(SMD=0.74,95%CI[0.56,0.91],P<0.00001),CD4~+/CD8~+(SMD=1.08,95%CI[0.44,1.72],P=0.0009)were superior to Western medicine treatment in terms of curative effect,and the difference was statistically significant(P<0.00001).There was no statistically significant difference in the efficacy of CD8~+(SMD=0.16,95%CI[-0.45,0.77],P=0.61).(2)A total of 7 studies in the included literature mentioned adverse reactions in clinical randomized controlled trials.Among them,4 studies indicated that no adverse reactions occurred during the process of Huaiqihuang Granules combined with conventional Western medicine treatment,and the remaining 3 studies were specific Describes the adverse reactions,mainly gastrointestinal discomfort and respiratory tract infection symptoms,and symptoms can disappear after symptomatic treatment.In summary,it is preliminarily believed that Huaiqihuang Granules combined with conventional Western medicine has small adverse reactions and good safety.(3)When the Q test is used for heterogeneity test,it is suggested that CD3~+,CD8~+,CD4~+/CD8~+are heterogeneous,and further sensitivity analysis can be obtained:Wang Na,Wu Fang’s study may be CD3~+,CD4~+/CD8~+heterogeneity The main source,reviewing the literature,may be related to the small sample size and statistical heterogeneity in the study of Wang Na and others.The specific situation of the baseline data of Wu Fang’s study sample is ominous and the clinical heterogeneity exists.After excluding these two studies,the results did not change significantly,indicating that the results are stable.The research of Wu Fang,Pang Zhanfeng,Zhao Shuang,etc.may be the main source of CD8~+heterogeneity.Reviewing the literature considers that the course of treatment may be the cause of the heterogeneity.Excluding these 3 studies,the meta-analysis results have changed significantly,and the difference in efficacy has changed from non-statistically significant to statistically significant,indicating that the stability of the results is poor,and more literature support is needed.(4)Taking the total effective rate as the outcome indicator,a total of 10 studies were included,and the funnel graphs were of general symmetry,and there was a possibility of publication bias.Using the cut-and-compensation method to combine the effect size,the numerical changes are not obvious,suggesting that the publication bias has little effect,and the meta-analysis results are relatively stable.3.According to GRADE method,the evidence quality of CD4~+is intermediate,the total effective rate,recurrence rate,CD3~+is low,and CD8~+,CD4~+/CD8~+is very low.Conclusion:Huaiqihuang Granules combined with Western medicine routine treatment of children with allergic purpura has a certain clinical effect,which can help regulate the immune function of children,reduce the recurrence rate,and have fewer adverse reactions,mild symptoms,and relatively high clinical safety.This meta-analysis has certain limitations due to the low overall quality of the included studies and the low level of evidence quality.Therefore,more high-quality,rigorously designed randomized controlled trials are needed for further verification. |
