Bayesian Network Meta-analysis Of Traditional Chinese Medicine In The Treatment Of Mild To Moderate Ulcerative Coliti

Objective:This study aimed to sort out the existing TCM(Traditional Chinese Medicine)interventions for the treatment of ulcerative colitis(UC),systematically review and compare the efficacy differences of different TCM interventions through network metaanalysis(NMA),and provide evidence-based medical evidence for clinical practice.Methods:The network meta-analysis process was performed in strict accordance with the Cochrane Manual for Evaluation.Systematic search of CNKI database,Weipu Chinese scientific and technological journal database(VIP),Wangfang database,China Biomedical Literature Database(Sinomed),PubMed database,Embase database,Web of science database,The Cochrane Library database,and the period is limited from January 1,2012 to November 20,2022.Randomized controlled trials(RCTs)of traditional Chinese medicine interventions for mild to moderate UC were included as required according to the criteria for inclusion and exclusion.The interventions included in the literature were as follows:Experimental group:only traditional Chinese medicine interventions,specific treatment modalities and content are not limited.Control group:The intervention is traditional Chinese medicine or Western medicine,and if Chinese medicine is used for treatment,the intervention method of traditional Chinese medicine used must be different from that of the experimental group.After data extraction,a network meta-analysis method under the Bayesian framework was used.Risk of bias assessment was assessed using the Cochrane Risk of Bias Risk Scale,published risk of bias was assessed by symmetry of the funnel plot,and risk of bias and funnel plots were drawn using RevMan software.We used the gemtc software package under Stata 15.0 and R 3.6.1 software to construct direct or indirect links between the included studies,and performed consistency analysis and analysis of data results.Network structure charts,league tables and rank ranking charts were drawn for each outcome indicator,the efficacy differences of different TCM interventions were compared,and the current best treatment plan was sought and finally the final conclusions were reasonably explained and discussed.Results:A total of 44 RCTs of traditional Chinese medicine intervention in the treatment of mild to moderate UC were included in this study,including 2088 patients with UC,and the baseline characteristics of the experimental group and the control group were comparable.The results of the network meta-analysis based on evidence-based medicine are as follows:(1)The interventions included in the study were systematically sorted out,and 9 traditional Chinese medicine interventions and 3 western medicine interventions were summarized:Chinese medicine oral,Chinese medicine enema,acupoint plaster,acupoint catgut embedding,Chinese medicine oral+Chinese medicine enema,Chinese medicine oral+acupuncture,Chinese medicine enema+acupuncture,Chinese medicine enema+acupoint catgut embedding,Chinese medicine enema+acupoint plaster,western medicine oral,western medicine enema,western medicine oral+western medicine enema.(2)Clinical efficacy:except for the interventions of acupoint catgut embedding and traditional Chinese medicine enema combined with plaster therapy,the clinical efficacy of the other 7 traditional Chinese medicine interventions was better than that of western oral therapy;Traditional Chinese medicine enema combined with acupoint catgut embedding[OR0.16,95%CL(0.02,0.90)]was superior to western medicine enema;Traditional Chinese medicine oral combined with Chinese medicine enema treatment was superior to western medicine oral combination with western medicine enema[OR0.34,95%CL(0.14,0.78)];Traditional Chinese medicine oral combined with Chinese medicine enema treatment was superior to traditional Chinese medicine oral treatment[OR0.43,95%CL(0.19,0.93)].(3)TCM syndrome points:1)There was no statistically significant difference in the efficacy of six interventions alleviating abdominal pain:acupoint plaster,Chinese medicine oral,Chinese medicine enema,Chinese medicine oral+Chinese medicine enema,Chinese medicine oral+acupuncture treatment,and western medicine oral treatment.2)Acupoint plaster therapy was superior to Western medicine oral therapy[MD2.69,95%CL(0.91,4.44)],Chinese medicine oral therapy[MD2.16,95%CL(0.20,4.06)]and Chinese medicine oral combined enema therapy[MD2.45,95%CL(0.38,4.45)]in improving diarrhea syndrome points;Traditional Chinese medicine oral combined with acupuncture was superior to Western medicine oral treatment[MD-0.95,95%CL(-1.77,-0.09)].3)There was no significant difference in the efficacy of six interventions:acupoint plaster,Chinese medicine oral,Chinese medicine enema,Chinese medicine oral+Chinese medicine enema,Chinese medicine oral+acupuncture,and western medicine oral,in improving the score of pus and blood stool syndrome.4)Baron score:Chinese medicine oral therapy was superior to Western medicine oral therapy in improving Baron endoscopic score in UC patients[MD-0.95,95%CL(-1.68,-0.16)];In addition,there was no significant difference in improving Baron scores between Chinese medicine enema combined with acupoint plaster,Chinese medicine enema combined with acupuncture,Chinese medicine oral,Chinese medicine oral combined enema,Chinese medicine oral combined with acupuncture,and Western medicine oral.5)Mayo score:Chinese medicine oral combined enema therapy was superior to Western medicine oral therapy in improving the Mayo score of UC patients[MD-2.20,95%CL(-3.67,-0.63)].In addition,there was no significant difference in the improvement of mayo scores between the interventions of Western medicine oral,western medicine oral combined enema,Chinese medicine enema combined with acupuncture,Chinese medicine oral,Chinese medicine oral combined enema,and Chinese medicine oral combined acupuncture.Conclusions:1.Clinically,Chinese medicine oral+Chinese medicine enema treatment has a higher efficacy than traditional Chinese medicine oral treatment of patients with mild to moderate UC,and the superimposed application of other traditional Chinese medicine interventions has no obvious advantages in clinical efficacy,improvement of traditional Chinese medicine syndrome and improvement of Baron score or mayo score compared with monotherapy.2.Acupoint plaster can also effectively treat UC,and it may be more advantageous than other interventions in the study in improving the clinical symptoms of abdominal pain and diarrhea.3.Traditional Chinese medicine enema can effectively improve the symptoms of pus and blood in patients with mild to moderate UC,and it may have advantages compared with other traditional Chinese medicine and Western medicine interventions.4.Oral Chinese medicine+ Chinese medicine enema can effectively improve the mayo score of UC patients,and it may have more advantages compared with other traditional Chinese medicine and Western medicine interventions.However,considering that the quality of the original studies included in this study is not high,the number of high-quality literature implemented and published by the included authoritative institutions is also limited,and the number of included literature such as acupoint plaster and acupuncture is small,we look forward to more high-quality,multi-center clinical studies in the future to verify the research conclusions of this study.