Clinical Evaluation Of Chinese Herbal Compound Combined With ESWL In The Treatment Of Kidney Stones Based On Meta-analysis

Objective: This study objectively evaluated the clinical efficacy of Traditional Chinese medicine(TCM)compound medicine combined with ESWL in the treatment of kidney stones through Meta-analysis,and summarized the deficiencies in the design and implementation of existing clinical studies,so as to provide evidence-based medicine evidence for TCM compound medicine combined with ESWL in the treatment of kidney stones,and provide reference for further clinical studies in the future.Methods: According to the purpose of the study,computer search terms and search formulas were determined,and each database was searched,and manual search was combined to comprehensively search the literature of TCM compound combined with ESWL in the treatment of kidney stones.The retrieval date is from the establishment to December 11,2020.All the retrieved literatures were imported into Noteexpress software.Duplicates were checked first to eliminate the duplicated literatures,and then the included literatures were selected according to the inclusion and exclusion criteria to determine the final included literatures.Excel was used to record the basic information and data of the included literatures,and the data were drawn into a three-line table.At the same time,Cochrane bias risk assessment tool was used to evaluate the literature quality of the included literatures,and the graph was drawn.Using Review Manager5.3 software to Meta analysis of literature data,analysis of outcome indicators mainly include:efficient,Scr,BUN,serum Cys C,inflammation index(TNF-α,IL-2,IL-6),T cell subsets(CD3+,CD4+,CD8+ and CD4+/CD8+),platoon stone time,recurrence rate,the results with that forest figure,now more than 10 for into literature,use the funnel chart analysis whether there is a publication bias,the last of all the results are analyzed.Results: Finally,22 literatures were included for analysis,including 2308 patients,including 1156 patients in the treatment group and 1152 patients in the control group.Meta-analysis was performed on 8outcome indicators of 22 literatures,and the results showed that the overall efficacy of ESWL plus TCM compound was better than that of the control group without TCM.(1)Effective rate:RR=1.2,95%CI [1.16,1.24],Z=10.23,P<0.00001,the difference was statistically significant;(2)Serum creatinine:MD=-12.48,95%CI[-13.07,-11.88],Z=41.05,P<0.00001,the difference was statistically significant;(3)Urea nitrogen:MD=-1.06,95%CI [-1.19,-0.93],Z=16.04,P<0.00001,the difference was statistically significant;(4)Serum Cys C:SMD=-0.81,95%CI [-1.30,-0.32],Z=3.26,P=0.001<0.05,the difference was statistically significant;(5)TNF-α:MD=-0.66,95%CI[-0.75,-0.61],Z=18.49,P<0.00001,the difference was statistically significant;IL-2: MD=-1.76,95%CI[-1.87,-1.66],Z=31.85,P<0.00001,the difference was statistically significant,IL-6: MD=-1.97,95%CI[-2.44,-1.49],Z=8.15,P<0.00001,the difference was statistically significant;(6)CD3+:MD=5.11,95%CI[3.92,6.30],Z=8.42,P<0.00001,the difference was statistically significant;CD4+:MD=3.81,95%CI[2.76,4.86],Z=7.13,P<0.00001;CD4+/CD8+:MD=0.18,95%CI[0.12,0.24],Z=5.49,P<0.00001,the difference was statistically significant;CD8+:MD=-0.19,95%CI[-0.88,0.50],Z=0.54,P(29)0.05;(7)Stoneremoving time:SMD=-3.21,95%CI[-4.10,-2.32],Z=7.06,P<0.00001,the difference was statistically significant;(8)Recurrence rate:RR=0.33,95%CI[0.13,0.88],Z=2.22,P=0.03<0.05,the difference was statistically significant;(9)According to the analysis of TCM compounds in 22 literatures,the traditional Chinese medicines that were used more than10 times were: Agaricum officinalis,Agaricum officinalis,Agaricum officinalis,Radix Achyranthes Radix,Licorice Radix,Shireed,Plantago Fructus,Radix Astragalus and Talc.According to the statistics of the categories of traditional Chinese medicines,they are mainly composed of dampness-enhancing drugs,defect-tonifying drugs,drugs to promote blood circulation and remove blood stasis,drugs to regulate qi,and drugs to clear heat,etc.The use of traditional Chinese medicines is basically consistent with the principles of traditional Chinese medicine treatment for kidney stones in clinical practice.Conclusions: Meta-analysis of this research results show that the traditional Chinese medicine compound with ESWL therapy kidney stones relative to ESWL treatment in improving clinical effectiveness,promote kidney function recovery(Scr,BUN,Cys C),improve inflammation(TNF alpha,IL-2,IL-6),protect the immune function(CD3+,CD4+,CD4+/CD8+),shorten the platoon stone curative effect more significant time,reduce the recurrence rate,etc.However,considering the low methodological quality of the included literatures in this study,the Meta results of this study were biased.It is expected that more high-quality RCTs can provide more accurate evidence-based medicine evidence for the treatment of kidney stones by TCM compound combined with ESWL in the future.