| Ulcerative colitis is a chronic non-specific intestinal inflammatory disease.The main disease area is in rectum and colon.The clinical symptoms are abdominal pain,diarrhea,mucus purulent stool and tenesmus.The cure rate of this disease is low,the recurrence rate is high,and it is closely related to the incidence of colon cancer,and has a rate of carcinogenesis.At present,western medicine makes corresponding medical plans according to different grades and stages of UC,while Chinese medicine classifies UC as "diarrhea","dysentery","intestinal wind","dirty poison" and so on categores,from the point of view of deficiency and excess of cold and heat,Chinese medicine was used for treatment.Huangqin decoction,known as "the progenitor of treating dysentery in the world",has a remarkable effect in clinical treatment of UC.EBM,meaned "evidence-based medicine",also known as empirical medicine.Evidence-based medicine is different from traditional medicine,it emphasizes that it should provide the best medical decision for clinical diagnosis,treatment and nurse on the basis of the best scientific research evidence,so as to improve the quality of life.Objective:A systematic review and meta analysis were made on the efficacy and safety of Huangqin decoction in the treatment of UC,and a reliable drug idea and guiding basis were provided for the clinical treatment of UC from the perspective of evidence-based medicine.Methods:Used China National Knowledge Infrastructure,China Science and Technology Journal Database,China Biology Medicine disc,Wanfang Database,Pub Med,Cochrane Library,Web of Science,Embase Database,to find out the randomized controlled trial of Huangqin decoction in the treatment of UC,the retrieval time is from the establishment of the database to August 2020,different databases used different retrieval methods.When the retrieval was completed,two independent researchers used Note Express v3.2.0.7629 software to screen the literature,incorporate the standard literature,establish the Excel data extraction table to complete the data extraction,and evaluate the quality of the incorporate literature through the Cochrane system evaluation manual,used Review Manager5.3 software for meta analysis,summarize the final analysis results and make qualitative evaluation.Results:A total of 15 literatures were included with a total of 1139 patients,and The quality of the included literature is ideal.Meta analysis showed that the curative rate [RR = 1.69,95% CI(1.44,1.98),Z = 6.54,P < 0.00001] and the total effective rate [RR = 1.25,95% CI(1.12,1.39),Z = 4.06,P <0.0001] of Huangqin decoction or Huangqin decoction combined with western medicine in the treatment of UC were significantly better than western medicine alone,the total effective rate of Huangqin decoction or Huangqin decoction combined with sulfasalazine in the treatment of UC was significantly higher than that of sulfasalazine alone [RR = 1.27,95% CI(1.02,1.59),Z = 2.11,P = 0.04],the total effective rate of Huangqin decoction or Huangqin decoction combined with mesalazine in the treatment of UC was significantly higher than that of mesalazine alone [RR = 1.23,95% CI(1.14,1.33),Z = 5.45,P < 0.00001].Compared with western medicine alone,Huangqin decoction or Huangqin decoction combined with western medicine could significantly reduce the overall clinical symptoms[MD =-2.16,95% CI(-2.62,-1.70),Z = 9.24,P < 0.00001],abdominal pain score [MD =-0.39,95% CI(-0.70,-0.07),Z = 2.42,P = 0.02] and tenesmus score [MD =-0.51,95% CI(-0.90,-0.12),Z = 2.58,P = 0.010],but reduce the diarrhea score [MD =-0.43,95% CI(-1.27,0.42),Z = 0.99,P = 0.32] and purulent stool score [MD =-0.15,95% CI(-1.49,1.20),Z =0.21,P = 0.83] is not obvious.Meanwhile,compared with western medicine alone,Huangqin decoction or Huangqin decoction combined with western medicine could significantly reduce the incidence of adverse reactions [RR =0.12,95% CI(0.05,0.29),Z = 4.77,P < 0.00001] and serum IL-1β level[SMD =-2.30,95% CI(-4.42,-0.17),Z = 2.12,P = 0.03],but reduced serum TNF-α level [SMD =-0.41,95% CI(-1.94,1.12),Z = 0.52,P = 0.60]and serum IL-6 level [SMD =-1.43,95% CI(-3.10,0.23),Z = 1.68,P =0.09] and increased serum IL-10 level [SMD = 1.16,95% CI(-0.41,2.73),Z = 1.45,P = 0.15] were not significant.Conclusion:1.The cure rate and total effective rate of Huangqin decoction or Huangqin decoction combined with western medicine in the treatment of UC were significantly higher than that of western medicine alone;the total effective rate of Huangqin decoction or Huangqin decoction combined with sulfasalazine in the treatment of UC was significantly higher than that of sulfasalazine alone,the total effective rate of Huangqin decoction or Huangqin decoction combined with mesalazine in the treatment of UC was significantly higher than that of mesalazine alone.2.Compared with western medicine alone,Huangqin decoction or Huangqin decoction combined with western medicine in the treatment of UC can better reduce the overall clinical symptom score,no significant difference of diarrhea score and purulent stool score,could significantly reduce abdominal pain score and tenesmus score,but the stability and reliability of the results are not high enough,which needs to be verified by further research.3.The incidence of adverse reactions of Huangqin decoction or Huangqin decoction combined with western medicine in the treatment of UC was significantly lower than that of western medicine alone,and the safety of Huangqin decoction or Huangqin decoction combined with western medicine was better.4.Compared with western medicine alone,Huangqin decoction or Huangqin decoction combined with western medicine in the treatment of UC can significantly reduce serum IL-1β level,there was no significant difference in serum IL-6 and IL-10 levels,but the stability and reliability of the results are not high enough,which need to be verified by further research,was no significant difference in serum TNF-α levels.5.This study has a certain guiding value for the clinical medication of Huangqin decoction in the treatment of UC: use Huangqin decoction or Huangqin decoction combined with western medicine in the treatment of UC is effective in the cure rate,total effective rate,improvement of abdominal pain and tenesmus clinical symptoms,regulation of serum inflammatory factor IL-1β It can be used according to the specific situation of patients in clinical;improve the clinical symptoms of diarrhea and purulent stool,and regulate the serum inflammatory factor TNF-α and terms of IL-6 and IL-10,there was no significant difference in the efficacy of Huangqin decoction or Huangqin decoction combined with western medicine compared with conventional western medicine,the relevant results still need more optimized design of large sample,multi center,high-quality clinical randomized controlled blind trials to improve and supplement. |
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