A Network Meta-analysis Of The Treatment Of UC With Classic Prescription Of Clearing Heat And Drying Dampness

Objective: To search the clinical randomized controlled trial of the treatment of ulcerative colitis with the classic prescription of clearing heat and drying dampness,and to explore the optimal treatment scheme of the prescription under different outcome indicators by using the network meta-analysis method.Methods: The databases of CNKI,Wanfang,VIP,sinomed,Pub Med,Embase and Cochrane Library were searched,it adopts the retrieval method of the combination of subject words and free words,to search the clinical Randomized controlled trial of baitouweng decoction,Shaoyao decoction,gegen qinlian decoction and Huangqin decoction in the treatment of ulcerative colitis from the establishment of the database to May 20,2022.All the documents in the databases were screened according to the inclusion and exclusion criteria,and all the documents in the databases were screened according to the inclusion and exclusion criteria,the data were extracted from the included literatures.This process is done by two researchers independently,cross-check after completion,if the two do not agree on the discussion or ask a third researcher to decide.The study selected six outcome measures,including total clinical response rate,incidence of adverse events,modified Mayo score,Baron Colonoscopy score,tumor necrosis factor levels,and recurrence rate.Stata 17 software was used to analyze the data,draw the graph,and rank the intervention measures under each outcome index.Results:A total of 1704 articles were retrieved from each database,repetitive articles were excluded,and the titles,abstracts and full texts were selected according to the inclusion and exclusion criteria,a total of 88 articles including 6,874 ulcerative colitis were included in the Meta-analysis,there were 8 interventions including "Routine treatment","Baitouweng decoction","Shaoyao decoction","Gegen qinlian decoction","Huangqin decoction","Baitouweng decoction and gegen qinlian decoction","Baitouweng decoction and shaoyao decoction" and "Shaoyao decoction and gegen qinlian decoction".The results of reticular meta-analysis:(1)Total Efficiency: A total of76 studies involving 8 interventions were included in the study,generating 28 pairwise comparisons,of which 11 were statistically significant.The order of the cumulative area of the total effective rate from high to low is: Shaoyao Decoction and Gegen Qinlian Decoction(SUBRA=80.1)>Shaoyao Decoction(SUBRA=71.4)>Gegen Qinlian Decoction(SUBRA=71.3)>Huangqin Decoction(SUBRA=60.9)>Baitouweng Decoction and Gegen Qinlian Decoction(SUBRA=51.2)>Baitouweng Decoction(SUBRA=48.7)>Routine Treatment(SUBRA=9.3)>Baitouweng Decoction and Shaoyao Decoction(SUBRA=7.3).(2)Incidence of adverse reactions: a total of 38 literature studies including incidence of adverse reactions,involving 7 interventions,generated 21 two-by-two comparisons,of which4 comparisons were statistically significant.The order of the cumulative area of SUBRA from high to low in the incidence of adverse reactions is:Huangqin Decoction(SUBRA=86.7)>Baitouweng Decoction(SUBRA=78.0)>Baitouweng Decoction and Gegen Qinlian Decoction(SUBRA=65.5)>Shaoyao Decoction(SUBRA=41.4)>Gegen Qinlian Decoction(SUBRA=39.5)>Baitouweng Decoction and Shaoyao Decoction(SUBRA=32.8)>conventional treatment(SUBRA=6.2).(3)Modified Mayo score:A total of 10 literature studies including the modified Mayo score,involving 5 interventions,generated 10 pairwise comparisons,each with no statistical significance.The order of the cumulative area of SUBRA from high to low in the modified Mayo score is: Gegen Qinlian Decoction(SUBRA=77.7)>Huangqin Decoction(SUBRA=61.4)>Shaoyao Decoction(SUBRA=55.9)>Baitouweng Decoction(SUBRA=42.9)>conventional treatment(SUBRA=12.2).(4)Colonoscopy score: there were 11 literature studies including colonoscopy score,involving 5 interventions,generating 10two-by-two comparisons,2 of which were statistically significant.The order of the cumulative area of SUCRA from high to low in the Baron score is: Shaoyao Decoction(SUCRA=71.4)>Baitouweng Decoction(SUCRA=68.8)>Gegen Qinlian Decoction(SUCRA=59.8)>Huangqin Decoction(SUCRA=46.0)>conventional treatment(SUCRA=4.1).(5)There were 34 articles including TNF-α level,including 6 kinds of intervention measures,and 15 kinds of comparison were made,4 of which were statistically significant.The order of the cumulative area of SUCRA from high to low in the TNF-α level is: Huangqin Decoction(SUBRA=92.5)>Gegen Qinlian Decoction(SUBRA=63.5)>Baitouweng Decoction=Shaoyao Decoction(SUBRA=49.7)>Shaoyao Decoction and Gegen Qinlian Decoction(SUBRA=37.0)>conventional treatment(SUBRA=7.7)(6)A total of 8literature studies including recurrence rate,involving 4 interventions,generated 6 pairs of comparison,of which 3 were significant.The order of the cumulative area of SUCRA from high to low in the recurrence rate is: Gegen Qinlian Decoction(SUBRA=76.9)>Baitouweng Decoction(SUBRA=70.3)>Shaoyao Decoction(SUBRA=52.0)>Routine treatment(SUCRA=0.8).Conclusion:(1)The four classical prescriptions for clearing heat and drying dampness have good therapeutic effects in all aspects of ulcerative colitis,but the combined use of the two prescriptions is not necessarily better than the single use.(2)Shaoyao Decoction and Gegen Qinlian Decoction can effectively improve the total effective rate;Huangqin Decoction has a good effect in reducing the incidence of adverse reactions and inhibiting the inflammatory factor TNF-α;Gegenqinlian Decoction was more effective in reducing the modified Mayo score and reducing the recurrence rate,while Shaoyao Decoction is most effective in reducing the enteroscopy score.