| Objective:A randomized controlled clinical trial was conducted to investigate the clinical efficacy of Modified Wumei Pills in the prevention of recurrence of colorectal adenomas after endoscopic treatment,and explored the relationship between intestinal microecology and the occurrence of colorectal adenomas.The clinical efficacy of taking Chinese medicine orally for the prevention of colorectal adenoma was evaluated by means of Meta analysis and systematic evaluation,which provided high-quality evidence for the prevention of colorectal adenoma by traditional Chinese medicine.Methods:(1)All clinical randomized controlled trails about oral administration of traditional Chinese medicine for the prevention of colorectal adenoma were searched from CNKI,Wanfang Data,VIP,CBM,PubMed,Cochrane Library,EMBASE.The search period was from inception to February,2019.The literature reading was independently completed according to the inclusion,exclusion criteria for literature screening,data extraction by two researchers.Meta analysis was carried out with RevMan5.3 software.(2)A11 subjects were from patients who underwent electronic colonoscopy in Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine from May 2017 to March 2019.Sixty patients who met the inclusion criteria of the experimental group were treated with endoscopic forceps or snares removal.After endoscopic treatment,one piece of normal mucosal tissue adjacent to the polyp was resected and quickly estored in liquid nitrogen.Eight subjects who met the inclusion criteria of the healthy population group resected a piece of normal colonic mucosa tissue with disposable biopsy forceps and quickly stored in liquid nitrogen.The mucosal tissue stored in liquid nitrogen was later transported to-80?refrigerator for freezing storage for high throughput sequencing.Sixty subjects in the experimental group were divided into treatment group and control group by computer generated random number method.After endoscopic treatment,the treatment group was given oral intervention of traditional Chinese medicine of Modified Wumei Pills,while the control group was not given any drug intervention.The oral course of traditional Chinese medicine was 3 months,and the enteroscopy was reexamined at the 6th month to evaluate the clinical efficacy.(3)The mucosal specimens stored in the refrigerator at-80? were extracted for DNA extraction and PCR amplification,fluorescence quantification,construction and sequencing of Miseq library,and bioinformatics analysis and statistics.The bacterial abundance and diversity of intestinal mucosa specimens from patients with colorectal adenoma and healthy people were compared.The patients with colorectal adenoma were divided into two groups,recurrence group and non-recurrence group,and the differences of bacterial abundance and diversity between the two groups were analyzed.Results:(1)Meta-analysis and systematic evaluation were finally included in 8 literatures.The results showed that the recurrence rate of colorectal adenomas in the experimental group treated with oral Chinese medicine after 0.5 years and 1 year were lower than that in the control group.The difference was statistically significant([RR=0.55,95%CI(0.36,0.83),Z=2.81,P=0.005],[RR=0.13,95%CI(0.05,0.34),Z=4.24,P<0.0001]).In the comprehensive evaluation of TCM symptoms,the effective rate of oral Chinese medicine treatment group was higher than that of control group one year after endoscopic treatment of colorectal adenoma(RR=1.24,95%CI(1.09,1.40),Z=3.4,P=0.0007).(2)A total of 60 patients were enrolled in the experimental group,30 in the treatment group and 30 in the control group.?In the evaluation of recurrence rate,among the inclusion analysis of 60 patients,the recurrence rate of the treatment group was 40.00%,and that of the control group was 66.67%.The recurrence rate of the treatment group was lower than that of the control group.Chi-square test,X2=4.286,P=0.038,showed that the recurrence rate of the two groups was significantly different(P<0.05).?In terms of the total score of clinical symptoms,the total score in the treatment group decreased after treatment compared with that before treatment(P<0.01),and the total score of clinical symptoms in the treatment group was lower than that in the control group after treatment(P<0.01),which showed that the difference was statistically significant.?In terms of the incidence and score of clinical symptoms,the incidence of clinical symptoms after treatment in the treatment group was lower than that before treatment.The results showed that the incidence and distribution of symptoms of mucous stool or mucous bloody stool,abdominal pain,constipation and abdominal distention were significantly different from those before treatment(P<0.05),which suggested that traditional Chinese medicine can effectively alleviate the symptoms of mucous stool or mucous bloody stool,abdominal pain,constipation and abdominal distension in patients with colorectal adenoma after endoscopic treatment.(3)Analysis of intestinal flora difference between patients with intestinal adenoma and healthy people:68 samples of colorectal adenoma patients and healthy people,obtained 4225 OTUs.At the level of the phylum,the abundance of the Firmicutes in the adenoma group was lower than that in the healthy control group,and the abundance of the Nitrospirae and Acidobacteria were higher than that of the healthy control group.The difference between the two groups was statistically significant(P<0.05).At the genus level,the abundance of the genus in the healthy control group was significantly higher than that in the adenoma group,including Pseudomonas,Faecalibacterium,Blautia,Dorea,Fusicatenibacter,and Eubacterium rectale(P<0.05);the abundance of the Escherichia-shigella in the adenoma group was significantly higher than that in the healthy control group(P<0.05).(4)Difference analysis of intestinal flora between recurrent group and non-recurrent group of colorectal adenoma:There was no significant difference in the abundance of dominant bacteria in the two groups,including Proteobacteria,Firmicutes,Bacteroidetes and Actinobacteria(P>0.05).At the generic level,the dominant bacteria in the two groups were Escherichia-Shigella,Bacteroides,Pseudomonas and Ruminococcus torques and there was no statistical difference between groups(P>0.05).Conclusions?Modified Wumei Pills can effectively reduce the recurrence rate of colorectal adenoma after 6 months of endoscopic treatment.?Modified Wumei Pills can effectively alleviate the clinical symptoms of mucus or mucus and bloody stools,abdominal pain,constipation and bloating in patients with colorectal adenoma.?The most common symptoms of patients with colorectal adenoma are abdominal pain,diarrhea,abdominal distension,followed by constipation,mucus or mucus and bloody stools,low back pain,reduced eating,abdominal mass and weight loss.?Intestinal flora of patients with colorectal adenoma and intestinal flora of healthy people have certain differences in the level of phylum and genus.?Patients with colorectal adenoma who had recurrence and no recurrence after endoscopic treatment,there was no significant difference in the the abundance of intestinal flora between the phylum and genus levels.?Meta-analysis results showed that oral administration of traditional Chinese medicine can effectively reduce the recurrence rate of colorectal adenoma after endoscopic treatment for 0.5 years and 1 year,and can effectively reduce the comprehensive efficacy score. |
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