Meta-Analysis Of Therapeutic Effect Of Clearing Heat,Removing Dampness And Blood Satsis On Ulcerative Colitis Of Large Instine Damp-Heat Syndrome

Objective;The purpose of this study was to evaluate the clinical efficacy and safety of clearing heat,removing dampness and blood in the treatment of ulcerative colitis by meta-analysis,and to provide reference for the clinical treatment and clinical research of ulcerative colitis treated by this method.Methods:By using the computer to search the commonly used Chinese and foreign medical databases Pub Med,Embase,Cochrane library,Chinse biomedical literature database,China national knowledge infrastrctre database,Wanfang database and VIP database.To collect all the randomized controlled clinical trials of clearing heat,promoting dampness and promoting blood circulation in the treatment of ulcerative colitis of large intestine damp-heat syndrome from the establishment of the database to May 2022.The searched literature titles are collected and imported into the Note Express document management software for literature screening.First,the imported literature is checked for the first time through the software repetition function,and then the unqualified literature studies are eliminated one by one according to the inclusion and exclusion criteria.Finally,the data of the included randomized controlled clinical trials are extracted,and the extracted data are summarized one by one on the Excel software to form a structured data set.And draw the flow chart of literature screening and the three-line table of basic data.This time,the Cochrane collaboration Network bias risk assessment tool is used to assess the risk of random allocation methods,allocation scheme concealment,research subjects,researchers and evaluators using blind method,integrity of result data,selective reporting of research results and other sources of bias.In order to avoid subjective bias in literature screening,evaluation and data extraction,the appeal task was completed by two researchers respectively,and the literature summary data were inputted into Review Manager5.4 software for Meta analysis.Outcome indicators:(1)TCM syndrome score;(2)clinical effect;(3)inflammatory factors;(4)mucosal healing rate;(5)adverse reactions;(6)IBDQ;(7)total score of TCM syndrome;(8)recurrence;(9)Sutherland DAI score;(10)mucosal improvement.The Review Manager5.4 software was used to judge the heterogeneity of literature data,according to the data belong to two-category variables or continuous variables,select the corresponding if the file heterogeneity is large,then need to use subgroup analysis,sensitivity analysis,Meta analysis regression to study the causes of heterogeneity.If the heterogeneity can not be reduced by appeal method,random effect model is selected to summarize the effect and draw the forest map.Funnel chart was used to evaluate the bias effect of randomized controlled trials when the number of original studies included was more than 10.Finally analyze the results.Result:Finally,20 literatures that met the requirements of randomized controlled trials were included,with a total of 1711subjects,including 859 in the control group and 852 in the intervention group.The method of clearing heat,promoting dampness and activating blood circulation in the treatment of ulcerative colitis can improve the clinical effective rate:I~2=0%,P=0.99,RR=1.22,95%CI[1.16,1.28],P<0.00001,the curative effect of TCM syndrome:I~2=0%,P=0.94,RR=1.26,95%CI[1.15,1.38],P<0.00001,and reduce the total score of TCM syndrome:I~2=47%,P=0.15,MD=-2.21,95%CI[-3.54,-0.89],P=0.001,abdominal pain,posterior tenesmsu,diarrhea,anal burning,mucous pus and blood stools,increased the level of anti-inflammatory factors,decreased the level of pro-inflammatory factors.Furthermore,improving mucosal healing rate:P=0.34,I~2=0%,RR=1.78,95%CI[1.28,2.48],P<0.0006,mucosal improvement:I~2=0%,P=0.6,RR=1.24,95%CI[1.07,1.44],P<0.004,IBDQ score:I~2=32%,P=0.21,MD=21.50,95%CI[19.74,23.25],P<0.00001,decreasing Sutherland DAI score:I~2=0%,P=0.82,MD=-1.58,95%CI[-2.04,-1.13],P<0.00001,adverse reactions I~2=0%,P=0.93,RR=0.48,95%CI[0.26,0.89],P=0.02,recurrence:I~2=0%,P=0.84,RR=0.42,95%CI[0.28,0.63],P<0.0001,the effect is more significant than that of western medicine alone.Analysis of the 19 groups included:The top ten most frequently used Chinese medicines were Coptis chinensis,licorice,Panax notoginseng,Phellodendron chinense,Radix Scutellariae,Radix Sanguisorba,Radix Paeoniae Alba,Radix Aucklandiae.According to the classification of drug efficacy,the most commonly used categories of traditional Chinese medicine are heat-clearing drugs,hemostatic drugs,deficiency-tonifying drugs,blood-activating drugs and qi-regulating drugs.Conclusions:In the treatment of ulcerative colitis,clearing heat and removing dampness and activating blood circulation is more effective than Western medicine in improving clinical efficacy,TCM syndrome efficacy,IBDQ score and mucosal improvement,reducing TCM syndrome score,inflammatory factors,adverse reactions,relapse rate and Sutherland DAI score,and improving mucosal healing.However,the 20 RCTs samples included in this study are relatively small,and the methodological quality of various randomized controlled trials is mediocre.More high-quality studies are needed to further confirm the efficacy of clearing heat and removing dampness and activating blood circulation in the treatment of UC.